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Маркеры активации системы гемостаза у больных с синдромом обструктивного апноэ сна, возможности краткосрочной СИПАП-терапии
Маркеры активации системы гемостаза у больных с синдромом обструктивного апноэ сна, возможности краткосрочной СИПАП-терапии
Бугаев Т.Д., Елфимова Е.М., Агеева Н.В. и др. Маркеры активации системы гемостаза у больных с синдромом обструктивного апноэ сна, возможности краткосрочной СИПАП-терапии. Системные гипертензии. 2016; 13 (4): 41–46.
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Аннотация
Цель исследования: изучить маркеры активации системы гемостаза, в частности D-димера, ингибитора активатора плазминогена-1 (ИАП-1), комплексов: плазмин-a2-антиплазмин (ПАП), тканевой активатор плазминогена/ИАП-1 (ТАП-ИАП-1); фактора Виллебранда и параметров вязкости цельной крови у пациентов с артериальной гипертонией (АГ) в сочетании с синдромом обструктивного апноэ сна (СОАС) разной степени тяжести, а также возможного влияния краткосрочной терапии постоянным положительным давлением в верхних дыхательных путях (СИПАП) в отношении данных показателей.
Материалы и методы. Включены 74 мужчины со средним возрастом 48 [40; 55] лет с АГ длительностью 8 [5; 10] лет, не принимающих антиагрегантную, антикоагулянтную терапию и не страдающих сахарным диабетом. Всем было проведено ночное кардиореспираторное исследование. По степени нарушения дыхания во время сна больные были разделены на 2 группы: 1-я группа – 34 пациента с АГ без СОАС и с СОАС легкой степени тяжести – индекс апноэ/гипопноэ – ИАГ 4,8 (2,6; 7,8); 2-я группа – 40 больных АГ и с СОАС тяжелой степени – ИАГ 50,2 (37,8; 75,2). Пациентам с тяжелой степенью СОАС проводилась эффективная СИПАП-терапия в течение 3–4 дней с определением анализов крови исходно и после терапии.
Результаты. У больных с тяжелой степенью СОАС были выявлены более высокие уровни вязкости цельной крови, маркеров активации системы гемостаза (ПАП, ТАП-ИАП-1), фибриногена и гематокрита. Значения комплекса ТАП-ИАП-1 и гематокрита превышали нормальные значения. На фоне СИПАП-терапии в течение 3–4 ночей в группе с тяжелым СОАС установлено достоверное снижение параметров вязкости цельной крови с достижением нормальных уровней гематокрита, тогда как маркеры активации системы гемостаза остались без достоверных изменений.
Заключение. Уровни маркеров активации системы гемостаза и параметры вязкости цельной крови повышены у лиц с СОАС тяжелой степени тяжести (АГ и ожирением). Краткосрочная (3–4 ночи) СИПАП-терапия благотворно влияет на все параметры вязкости цельной крови, снижая уровень гематокрита до нормальных параметров.
Ключевые слова: нарушение дыхания во сне, синдром обструктивного апноэ сна, коагулогия, гемостаз, фибринолизис, вязкость крови, СИПАП-терапия.
Materials and methods. We included 74 middle-aged (mean age 48 [40; 55] years) male patients with arterial hypertension (AH) of average duration 8 [5; 10] years without antiplatelet, anticoagulant therapy and diabetes mellitus. All patients underwent sleep breathing study. According to the severity of OSA, patients were divided into 2 groups: 40 patients with severe OSA – apnea/hypopnea index – AHI 50.2 (37.8; 75.2) and control group with 34 patients with mild or no OSA – AHI 4.8 (2.6; 7.8). In all patients were analyzed markers of hemostasis system and parameters of whole blood viscosity; 34 patients with severe OSA underwent 3–4 nights of effective CPAP therapy (with achievement AHI<5) with evaluation of the above analysis at baseline and in the end of therapy.
Results. We found a significant increase of fibrinogen, plasminogen activator inhibitor-1 (PAI-1), plasmin-a2-antiplasmin complex (PAP), tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPA-PAI-1), whole blood viscosity at low shear rates and erythrocytes aggregation index in the group with severe OSA compared with controls. After short-term (3–4 nights) CPAP therapy significantly decreased all parameters of whole blood viscosity with achieved normal levels of hematocrit, but markers of hemostasis system showed no significant difference.
Conclusion: the coagulation status of blood is elevated in severe OSA patients (with AH and obessity). Short-term CPAP therapy can improve parameters of whole blood viscosity with achieved normal values of hematocrit. These results suggest that even few nights of CPAP therapy may reduce cardiovascular risk in OSA, in part through improving of whole blood viscosity.
Key words: disorders of breathing during sleep, obstructive sleep apnea, coagulation markers, blood viscosity, CPAP therapy.
Материалы и методы. Включены 74 мужчины со средним возрастом 48 [40; 55] лет с АГ длительностью 8 [5; 10] лет, не принимающих антиагрегантную, антикоагулянтную терапию и не страдающих сахарным диабетом. Всем было проведено ночное кардиореспираторное исследование. По степени нарушения дыхания во время сна больные были разделены на 2 группы: 1-я группа – 34 пациента с АГ без СОАС и с СОАС легкой степени тяжести – индекс апноэ/гипопноэ – ИАГ 4,8 (2,6; 7,8); 2-я группа – 40 больных АГ и с СОАС тяжелой степени – ИАГ 50,2 (37,8; 75,2). Пациентам с тяжелой степенью СОАС проводилась эффективная СИПАП-терапия в течение 3–4 дней с определением анализов крови исходно и после терапии.
Результаты. У больных с тяжелой степенью СОАС были выявлены более высокие уровни вязкости цельной крови, маркеров активации системы гемостаза (ПАП, ТАП-ИАП-1), фибриногена и гематокрита. Значения комплекса ТАП-ИАП-1 и гематокрита превышали нормальные значения. На фоне СИПАП-терапии в течение 3–4 ночей в группе с тяжелым СОАС установлено достоверное снижение параметров вязкости цельной крови с достижением нормальных уровней гематокрита, тогда как маркеры активации системы гемостаза остались без достоверных изменений.
Заключение. Уровни маркеров активации системы гемостаза и параметры вязкости цельной крови повышены у лиц с СОАС тяжелой степени тяжести (АГ и ожирением). Краткосрочная (3–4 ночи) СИПАП-терапия благотворно влияет на все параметры вязкости цельной крови, снижая уровень гематокрита до нормальных параметров.
Ключевые слова: нарушение дыхания во сне, синдром обструктивного апноэ сна, коагулогия, гемостаз, фибринолизис, вязкость крови, СИПАП-терапия.
________________________________________________
Materials and methods. We included 74 middle-aged (mean age 48 [40; 55] years) male patients with arterial hypertension (AH) of average duration 8 [5; 10] years without antiplatelet, anticoagulant therapy and diabetes mellitus. All patients underwent sleep breathing study. According to the severity of OSA, patients were divided into 2 groups: 40 patients with severe OSA – apnea/hypopnea index – AHI 50.2 (37.8; 75.2) and control group with 34 patients with mild or no OSA – AHI 4.8 (2.6; 7.8). In all patients were analyzed markers of hemostasis system and parameters of whole blood viscosity; 34 patients with severe OSA underwent 3–4 nights of effective CPAP therapy (with achievement AHI<5) with evaluation of the above analysis at baseline and in the end of therapy.
Results. We found a significant increase of fibrinogen, plasminogen activator inhibitor-1 (PAI-1), plasmin-a2-antiplasmin complex (PAP), tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPA-PAI-1), whole blood viscosity at low shear rates and erythrocytes aggregation index in the group with severe OSA compared with controls. After short-term (3–4 nights) CPAP therapy significantly decreased all parameters of whole blood viscosity with achieved normal levels of hematocrit, but markers of hemostasis system showed no significant difference.
Conclusion: the coagulation status of blood is elevated in severe OSA patients (with AH and obessity). Short-term CPAP therapy can improve parameters of whole blood viscosity with achieved normal values of hematocrit. These results suggest that even few nights of CPAP therapy may reduce cardiovascular risk in OSA, in part through improving of whole blood viscosity.
Key words: disorders of breathing during sleep, obstructive sleep apnea, coagulation markers, blood viscosity, CPAP therapy.
Полный текст
Список литературы
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3. Guilleminault C, Eldridge F, Dement W. Insomnia with sleep apnea: a new syndrome. Science 1973; 181: 856–8.
4. Sullivan CE, Issa FG, Berthon-Jones M et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225): 862–5.
5. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension Gianfranco. Eur Respir J 2013; 41: 523–38.
6. Shahar E, Whitney C, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 200; 163 (1): 19–25.
7. Young T, Finn L, Peppard P et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31 (8): 1071–8.
8. Lee J-E, Lee CH, Lee SJ et al. Mortality of Patients with Obstructive Sleep Apnea in Korea. J Clin Sleep Med 2013; 9 (10): 997–1002.
9. Lavie P, Hoffstein V. Sleep apnea syndrome: a possible contributing factor to resistant hypertension. Sleep 2001; 24 (6): 721–5.
10. Grote L, Hedner J, Peter J. Sleep-related breathing disorder is an independent risk factor for uncontrolled hypertension. J Hypertens 2000; 18 (6): 679–85.
11. Khan A, Patel NK, O’Hearn DJ et al. Resistant Hypertension and Obstructive Sleep Apnea. Int J Hypertens 2013; 2013: Article ID 193010.
12. Frenţ S, Tudorache V, Ardelean C et al. Sleep apnea syndrome – cause of resistance to treatment of arterial hypertension. Pneumologia 2011; 60 (4): 202–7.
13. Logan A, Perlikowski S, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19 (12): 2271–7.
14. Szyguła-Jurkiewicz B, Hudzik B, Nowak J et al. Sleep apnea syndrome in patients with chronic heart failure. Wiad Lek 2004; 57 (3–4): 161–5.
15. Naughton MT, Bradley TD. Sleep apnea in congestive heart failure. Clin Chest Med 1998; 19 (1): 99–113.
16. Mehra R, Benjamin EJ, Shahar E et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173 (8): 910–6.
17. Gami AS, Pressman G, Caples SM et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004; 110 (4): 364–7.
18. Monahan K, Brewster J, Wang L et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2012; 110 (3): 369–72.
19. Jennum P, Soul A. Epidemiology of snoring and obstructive sleep apnoea in the Dannish population age 30-60. J Sleep Res 1992; 1: 240–4.
20. Young T, Zaccaro D, Leder R et al. Prevalence and correlates of sleep disordered breathing in the Wisconsin sleep cohort study. Am Rev Respir Dis 1991; 143: A380.
21. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46 (2): 85–90.
22. Marin JM, Gascon JM, Carrizo S et al. Prevalence of sleep apnoea syndrome in the Spanish adult population. Int J Epidemiol 1997; 26 (2): 381–6.
23. Quintana-Gallego E, Carmona-Bernal C, Capote F et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 2004; 98: 984–9.
24. Wild S, Roglic G, Green A et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27 (5): 1053.
25. Zhang W, Chen X, Ma L et al. Epidemiology of bronchial asthma and asthma control assessment in Henan Province. China Translation Respir Med 2014; 2: 5.
26. Lindberg E, Elmasry A, Gislason T. Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med 1999; 159 (6): 2024–7.
27. Davies RJ, Stradling JR. The epidemiology of sleep apnoea. Thorax 1996; 51 (Suppl. 2): S65–S70.
28. Pal'man A.D. Sindrom obstruktivnogo apnoe vo sne v klinike vnutrennikh boleznei. Pod red. A.I.Sinopal'nikova. М., 2007; s. 13–5. [in Russian]
29. Aksenova A.V., Elfimova E.M., Galitsin P.V. et al. Role of the Pulse Oximetry in the cardiologist's practice. Systemic Hypertension. 2014; 11 (4): 26–30. [in Russian]
30. Shakhmatov I.I. et al. Sostoianie sistemy gemostaza pri razlichnykh vidakh gipoksicheskogo vozdeistviia. Biulleten' SO RAMN. 2010; 30 (2): 131–8. [in Russian]
31. Peng YH, Liao WC, Chung WS et al. Association between obstructive sleep apnea and deep vein thrombosis/pulmonary embolism: a population-based retrospective cohort study. Thromb Res 2014; 34: 340–5.
32. Nobili L, Schiavi G, Bozano E et al. Morning increase of whole blood viscosity in obstructive sleep apnea syndrome. Clin Hemorheol Microcirc 2000; 22 (1): 21–7.
33. Steiner S, Jax T, Evers S et al. Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk. Cardiology 2005; 104 (2): 92–6.
34. Dikmenoğlu N, Ciftçi B, Ileri E et al. Erythrocyte deformability, plasma viscosity and oxidative status in patients with severe obstructive sleep apnea syndrome. Sleep Med 2006; 7 (3): 255–61.
35. Robinson GV, Pepperell JC, Segal HC et al. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax 2004; 59 (9): 777–82.
36. Wessendorf TE, Thilmann AF, Wang YM et al. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med 2000; 162 (6): 2039–42.
37. Hayashi M, Fujimoto K, Urushibata K et al. Respirology. Hypoxia-sensitive molecules may modulate the development of atherosclerosis in sleep apnoea syndrome. Respirology 2006; 11 (1): 24–31.
38. Shimizu M, Kamio K, Haida M et al. Platelet activation in patients with obstructive sleep apnea syndrome and effects of nasal-continuous positive airway pressure. Tokai J Exp Clin Med 2002; 27 (4): 107–12.
39. Geiser T, Buck F, Meyer B et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002; 69 (3): 229–34.
40. El Solh AA, Akinnusi ME, Berim IG et al. Hemostatic implications of endothelial cell apoptosis in obstructive sleep apnea. Sleep Breath 2008; 12 (4): 331–7.
41. Shitrit D, Peled N et al. An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome. Thromb Haemost 2005; 94 (3): 544–7.
42. Ishikawa J, Hoshide S, Eguchi K et al. Increased low-grade inflammation and plasminogen-activator inhibitor-1 level in nondippers with sleep apnea syndrome. J Hypertens 2008; 26 (6): 1181–7.
43. Zamarrón C, Ricoy J, Riveiro A et al. Plasminogen activator inhibitor-1 in obstructive sleep apnea patients with and without hypertension. Lung 2008; 186 (3): 151–6.
44. Tazbirek M, Slowinska L, Skoczynski S et al. Short-term continuous positive airway pressure therapy reverses the pathological influence of obstructive sleep apnea on blood rheology parameters. Clin Hemorheol Microcirc 2009; 41 (4): 241–9.
45. Hui DS, Ko FW, Fok JP et al. The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome. Chest 2004; 125 (5): 1768–75.
46. Akinnusi ME, Paasch LL, Szarpa KR et al. Impact of nasal continuous positive airway pressure therapy on markers of platelet activation in patients with obstructive sleep apnea. Respiration 2009; 77 (1): 25–31.
47. Zhang X, Yin K, Wang H et al. Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state. Chin Med J (Engl) 2003; 116 (9): 1426–8.
48. von Känel R, Loredo J, Ancoli-Israel S et al. Association between sleep apnea severity and blood coagulability: Treatment effects of nasal continuous positive airway pressure. Sleep Breath 2006; 10 (3): 139–46.
49. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 2013; 41: 523–38.
50. Ageeva N.V. Sostoianie perifericheskoi gemodinamiki, mikrotsirkuliatsii i reologicheskikh svoistv krovi u bol'nykh semeinoi giperkholesterinemiei pri medikamentoznom i ekstrakorporal'nom metodakh lecheniia. Avtoref. dis. … kand. med. nauk. M., 1998. [in Russian]
51. Zubieta-Calleja GR, Paulev PE, Zubieta-Calleja L et al. Altitude adaptation through hematocrit changes. J Physiol Pharmacol 2007.
2. McGregor MI, Block AJ, Ball WS. Serious complications and sudden death in the Pickwickian syndrome. Johns Hopkins Med J 1970; 126–127: 279–95.
3. Guilleminault C, Eldridge F, Dement W. Insomnia with sleep apnea: a new syndrome. Science 1973; 181: 856–8.
4. Sullivan CE, Issa FG, Berthon-Jones M et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225): 862–5.
5. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension Gianfranco. Eur Respir J 2013; 41: 523–38.
6. Shahar E, Whitney C, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 200; 163 (1): 19–25.
7. Young T, Finn L, Peppard P et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31 (8): 1071–8.
8. Lee J-E, Lee CH, Lee SJ et al. Mortality of Patients with Obstructive Sleep Apnea in Korea. J Clin Sleep Med 2013; 9 (10): 997–1002.
9. Lavie P, Hoffstein V. Sleep apnea syndrome: a possible contributing factor to resistant hypertension. Sleep 2001; 24 (6): 721–5.
10. Grote L, Hedner J, Peter J. Sleep-related breathing disorder is an independent risk factor for uncontrolled hypertension. J Hypertens 2000; 18 (6): 679–85.
11. Khan A, Patel NK, O’Hearn DJ et al. Resistant Hypertension and Obstructive Sleep Apnea. Int J Hypertens 2013; 2013: Article ID 193010.
12. Frenţ S, Tudorache V, Ardelean C et al. Sleep apnea syndrome – cause of resistance to treatment of arterial hypertension. Pneumologia 2011; 60 (4): 202–7.
13. Logan A, Perlikowski S, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19 (12): 2271–7.
14. Szyguła-Jurkiewicz B, Hudzik B, Nowak J et al. Sleep apnea syndrome in patients with chronic heart failure. Wiad Lek 2004; 57 (3–4): 161–5.
15. Naughton MT, Bradley TD. Sleep apnea in congestive heart failure. Clin Chest Med 1998; 19 (1): 99–113.
16. Mehra R, Benjamin EJ, Shahar E et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173 (8): 910–6.
17. Gami AS, Pressman G, Caples SM et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004; 110 (4): 364–7.
18. Monahan K, Brewster J, Wang L et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2012; 110 (3): 369–72.
19. Jennum P, Soul A. Epidemiology of snoring and obstructive sleep apnoea in the Dannish population age 30-60. J Sleep Res 1992; 1: 240–4.
20. Young T, Zaccaro D, Leder R et al. Prevalence and correlates of sleep disordered breathing in the Wisconsin sleep cohort study. Am Rev Respir Dis 1991; 143: A380.
21. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46 (2): 85–90.
22. Marin JM, Gascon JM, Carrizo S et al. Prevalence of sleep apnoea syndrome in the Spanish adult population. Int J Epidemiol 1997; 26 (2): 381–6.
23. Quintana-Gallego E, Carmona-Bernal C, Capote F et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 2004; 98: 984–9.
24. Wild S, Roglic G, Green A et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27 (5): 1053.
25. Zhang W, Chen X, Ma L et al. Epidemiology of bronchial asthma and asthma control assessment in Henan Province. China Translation Respir Med 2014; 2: 5.
26. Lindberg E, Elmasry A, Gislason T. Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med 1999; 159 (6): 2024–7.
27. Davies RJ, Stradling JR. The epidemiology of sleep apnoea. Thorax 1996; 51 (Suppl. 2): S65–S70.
28. Пальман А.Д. Синдром обструктивного апноэ во сне в клинике внутренних болезней. Под ред. А.И.Синопальникова. М., 2007; с. 13–5. / Pal'man A.D. Sindrom obstruktivnogo apnoe vo sne v klinike vnutrennikh boleznei. Pod red. A.I.Sinopal'nikova. М., 2007; s. 13–5. [in Russian]
29. Аксенова А.В., Елфимова Е.М., Галицин П.В. и др. Значение компьютерной пульсоксиметрии в практике врача-кардиолога. Системные гипертензии. 2014; 11 (4): 26–30. / Aksenova A.V., Elfimova E.M., Galitsin P.V. et al. Role of the Pulse Oximetry in the cardiologist's practice. Systemic Hypertension. 2014; 11 (4): 26–30. [in Russian]
30. Шахматов И.И. и др. Состояние системы гемостаза при различных видах гипоксического воздействия. Бюллетень СО РАМН. 2010; 30 (2): 131–8. / Shakhmatov I.I. et al. Sostoianie sistemy gemostaza pri razlichnykh vidakh gipoksicheskogo vozdeistviia. Biulleten' SO RAMN. 2010; 30 (2): 131–8. [in Russian]
31. Peng YH, Liao WC, Chung WS et al. Association between obstructive sleep apnea and deep vein thrombosis/pulmonary embolism: a population-based retrospective cohort study. Thromb Res 2014; 34: 340–5.
32. Nobili L, Schiavi G, Bozano E et al. Morning increase of whole blood viscosity in obstructive sleep apnea syndrome. Clin Hemorheol Microcirc 2000; 22 (1): 21–7.
33. Steiner S, Jax T, Evers S et al. Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk. Cardiology 2005; 104 (2): 92–6.
34. Dikmenoğlu N, Ciftçi B, Ileri E et al. Erythrocyte deformability, plasma viscosity and oxidative status in patients with severe obstructive sleep apnea syndrome. Sleep Med 2006; 7 (3): 255–61.
35. Robinson GV, Pepperell JC, Segal HC et al. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax 2004; 59 (9): 777–82.
36. Wessendorf TE, Thilmann AF, Wang YM et al. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med 2000; 162 (6): 2039–42.
37. Hayashi M, Fujimoto K, Urushibata K et al. Respirology. Hypoxia-sensitive molecules may modulate the development of atherosclerosis in sleep apnoea syndrome. Respirology 2006; 11 (1): 24–31.
38. Shimizu M, Kamio K, Haida M et al. Platelet activation in patients with obstructive sleep apnea syndrome and effects of nasal-continuous positive airway pressure. Tokai J Exp Clin Med 2002; 27 (4): 107–12.
39. Geiser T, Buck F, Meyer B et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002; 69 (3): 229–34.
40. El Solh AA, Akinnusi ME, Berim IG et al. Hemostatic implications of endothelial cell apoptosis in obstructive sleep apnea. Sleep Breath 2008; 12 (4): 331–7.
41. Shitrit D, Peled N et al. An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome. Thromb Haemost 2005; 94 (3): 544–7.
42. Ishikawa J, Hoshide S, Eguchi K et al. Increased low-grade inflammation and plasminogen-activator inhibitor-1 level in nondippers with sleep apnea syndrome. J Hypertens 2008; 26 (6): 1181–7.
43. Zamarrón C, Ricoy J, Riveiro A et al. Plasminogen activator inhibitor-1 in obstructive sleep apnea patients with and without hypertension. Lung 2008; 186 (3): 151–6.
44. Tazbirek M, Slowinska L, Skoczynski S et al. Short-term continuous positive airway pressure therapy reverses the pathological influence of obstructive sleep apnea on blood rheology parameters. Clin Hemorheol Microcirc 2009; 41 (4): 241–9.
45. Hui DS, Ko FW, Fok JP et al. The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome. Chest 2004; 125 (5): 1768–75.
46. Akinnusi ME, Paasch LL, Szarpa KR et al. Impact of nasal continuous positive airway pressure therapy on markers of platelet activation in patients with obstructive sleep apnea. Respiration 2009; 77 (1): 25–31.
47. Zhang X, Yin K, Wang H et al. Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state. Chin Med J (Engl) 2003; 116 (9): 1426–8.
48. von Känel R, Loredo J, Ancoli-Israel S et al. Association between sleep apnea severity and blood coagulability: Treatment effects of nasal continuous positive airway pressure. Sleep Breath 2006; 10 (3): 139–46.
49. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 2013; 41: 523–38.
50. Агеева Н.В. Состояние периферической гемодинамики, микроциркуляции и реологических свойств крови у больных семейной гиперхолестеринемией при медикаментозном и экстракорпоральном методах лечения. Автореф. дис. … канд. мед. наук. М., 1998. / Ageeva N.V. Sostoianie perifericheskoi gemodinamiki, mikrotsirkuliatsii i reologicheskikh svoistv krovi u bol'nykh semeinoi giperkholesterinemiei pri medikamentoznom i ekstrakorporal'nom metodakh lecheniia. Avtoref. dis. … kand. med. nauk. M., 1998. [in Russian]
51. Zubieta-Calleja GR, Paulev PE, Zubieta-Calleja L et al. Altitude adaptation through hematocrit changes. J Physiol Pharmacol 2007.
________________________________________________
2. McGregor MI, Block AJ, Ball WS. Serious complications and sudden death in the Pickwickian syndrome. Johns Hopkins Med J 1970; 126–127: 279–95.
3. Guilleminault C, Eldridge F, Dement W. Insomnia with sleep apnea: a new syndrome. Science 1973; 181: 856–8.
4. Sullivan CE, Issa FG, Berthon-Jones M et al. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1981; 1 (8225): 862–5.
5. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension Gianfranco. Eur Respir J 2013; 41: 523–38.
6. Shahar E, Whitney C, Redline S et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 200; 163 (1): 19–25.
7. Young T, Finn L, Peppard P et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008; 31 (8): 1071–8.
8. Lee J-E, Lee CH, Lee SJ et al. Mortality of Patients with Obstructive Sleep Apnea in Korea. J Clin Sleep Med 2013; 9 (10): 997–1002.
9. Lavie P, Hoffstein V. Sleep apnea syndrome: a possible contributing factor to resistant hypertension. Sleep 2001; 24 (6): 721–5.
10. Grote L, Hedner J, Peter J. Sleep-related breathing disorder is an independent risk factor for uncontrolled hypertension. J Hypertens 2000; 18 (6): 679–85.
11. Khan A, Patel NK, O’Hearn DJ et al. Resistant Hypertension and Obstructive Sleep Apnea. Int J Hypertens 2013; 2013: Article ID 193010.
12. Frenţ S, Tudorache V, Ardelean C et al. Sleep apnea syndrome – cause of resistance to treatment of arterial hypertension. Pneumologia 2011; 60 (4): 202–7.
13. Logan A, Perlikowski S, Mente A et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19 (12): 2271–7.
14. Szyguła-Jurkiewicz B, Hudzik B, Nowak J et al. Sleep apnea syndrome in patients with chronic heart failure. Wiad Lek 2004; 57 (3–4): 161–5.
15. Naughton MT, Bradley TD. Sleep apnea in congestive heart failure. Clin Chest Med 1998; 19 (1): 99–113.
16. Mehra R, Benjamin EJ, Shahar E et al. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173 (8): 910–6.
17. Gami AS, Pressman G, Caples SM et al. Association of atrial fibrillation and obstructive sleep apnea. Circulation 2004; 110 (4): 364–7.
18. Monahan K, Brewster J, Wang L et al. Relation of the severity of obstructive sleep apnea in response to anti-arrhythmic drugs in patients with atrial fibrillation or atrial flutter. Am J Cardiol 2012; 110 (3): 369–72.
19. Jennum P, Soul A. Epidemiology of snoring and obstructive sleep apnoea in the Dannish population age 30-60. J Sleep Res 1992; 1: 240–4.
20. Young T, Zaccaro D, Leder R et al. Prevalence and correlates of sleep disordered breathing in the Wisconsin sleep cohort study. Am Rev Respir Dis 1991; 143: A380.
21. Stradling JR, Crosby JH. Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men. Thorax 1991; 46 (2): 85–90.
22. Marin JM, Gascon JM, Carrizo S et al. Prevalence of sleep apnoea syndrome in the Spanish adult population. Int J Epidemiol 1997; 26 (2): 381–6.
23. Quintana-Gallego E, Carmona-Bernal C, Capote F et al. Gender differences in obstructive sleep apnea syndrome: a clinical study of 1166 patients. Respir Med 2004; 98: 984–9.
24. Wild S, Roglic G, Green A et al. Global prevalence of diabetes estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27 (5): 1053.
25. Zhang W, Chen X, Ma L et al. Epidemiology of bronchial asthma and asthma control assessment in Henan Province. China Translation Respir Med 2014; 2: 5.
26. Lindberg E, Elmasry A, Gislason T. Evolution of sleep apnea syndrome in sleepy snorers: a population-based prospective study. Am J Respir Crit Care Med 1999; 159 (6): 2024–7.
27. Davies RJ, Stradling JR. The epidemiology of sleep apnoea. Thorax 1996; 51 (Suppl. 2): S65–S70.
28. Pal'man A.D. Sindrom obstruktivnogo apnoe vo sne v klinike vnutrennikh boleznei. Pod red. A.I.Sinopal'nikova. М., 2007; s. 13–5. [in Russian]
29. Aksenova A.V., Elfimova E.M., Galitsin P.V. et al. Role of the Pulse Oximetry in the cardiologist's practice. Systemic Hypertension. 2014; 11 (4): 26–30. [in Russian]
30. Shakhmatov I.I. et al. Sostoianie sistemy gemostaza pri razlichnykh vidakh gipoksicheskogo vozdeistviia. Biulleten' SO RAMN. 2010; 30 (2): 131–8. [in Russian]
31. Peng YH, Liao WC, Chung WS et al. Association between obstructive sleep apnea and deep vein thrombosis/pulmonary embolism: a population-based retrospective cohort study. Thromb Res 2014; 34: 340–5.
32. Nobili L, Schiavi G, Bozano E et al. Morning increase of whole blood viscosity in obstructive sleep apnea syndrome. Clin Hemorheol Microcirc 2000; 22 (1): 21–7.
33. Steiner S, Jax T, Evers S et al. Altered blood rheology in obstructive sleep apnea as a mediator of cardiovascular risk. Cardiology 2005; 104 (2): 92–6.
34. Dikmenoğlu N, Ciftçi B, Ileri E et al. Erythrocyte deformability, plasma viscosity and oxidative status in patients with severe obstructive sleep apnea syndrome. Sleep Med 2006; 7 (3): 255–61.
35. Robinson GV, Pepperell JC, Segal HC et al. Circulating cardiovascular risk factors in obstructive sleep apnoea: data from randomised controlled trials. Thorax 2004; 59 (9): 777–82.
36. Wessendorf TE, Thilmann AF, Wang YM et al. Fibrinogen levels and obstructive sleep apnea in ischemic stroke. Am J Respir Crit Care Med 2000; 162 (6): 2039–42.
37. Hayashi M, Fujimoto K, Urushibata K et al. Respirology. Hypoxia-sensitive molecules may modulate the development of atherosclerosis in sleep apnoea syndrome. Respirology 2006; 11 (1): 24–31.
38. Shimizu M, Kamio K, Haida M et al. Platelet activation in patients with obstructive sleep apnea syndrome and effects of nasal-continuous positive airway pressure. Tokai J Exp Clin Med 2002; 27 (4): 107–12.
39. Geiser T, Buck F, Meyer B et al. In vivo platelet activation is increased during sleep in patients with obstructive sleep apnea syndrome. Respiration 2002; 69 (3): 229–34.
40. El Solh AA, Akinnusi ME, Berim IG et al. Hemostatic implications of endothelial cell apoptosis in obstructive sleep apnea. Sleep Breath 2008; 12 (4): 331–7.
41. Shitrit D, Peled N et al. An association between oxygen desaturation and D-dimer in patients with obstructive sleep apnea syndrome. Thromb Haemost 2005; 94 (3): 544–7.
42. Ishikawa J, Hoshide S, Eguchi K et al. Increased low-grade inflammation and plasminogen-activator inhibitor-1 level in nondippers with sleep apnea syndrome. J Hypertens 2008; 26 (6): 1181–7.
43. Zamarrón C, Ricoy J, Riveiro A et al. Plasminogen activator inhibitor-1 in obstructive sleep apnea patients with and without hypertension. Lung 2008; 186 (3): 151–6.
44. Tazbirek M, Slowinska L, Skoczynski S et al. Short-term continuous positive airway pressure therapy reverses the pathological influence of obstructive sleep apnea on blood rheology parameters. Clin Hemorheol Microcirc 2009; 41 (4): 241–9.
45. Hui DS, Ko FW, Fok JP et al. The effects of nasal continuous positive airway pressure on platelet activation in obstructive sleep apnea syndrome. Chest 2004; 125 (5): 1768–75.
46. Akinnusi ME, Paasch LL, Szarpa KR et al. Impact of nasal continuous positive airway pressure therapy on markers of platelet activation in patients with obstructive sleep apnea. Respiration 2009; 77 (1): 25–31.
47. Zhang X, Yin K, Wang H et al. Effect of continuous positive airway pressure treatment on elderly Chinese patients with obstructive sleep apnea in the prethrombotic state. Chin Med J (Engl) 2003; 116 (9): 1426–8.
48. von Känel R, Loredo J, Ancoli-Israel S et al. Association between sleep apnea severity and blood coagulability: Treatment effects of nasal continuous positive airway pressure. Sleep Breath 2006; 10 (3): 139–46.
49. Parati G, Lombardi C, Hedner J et al. Recommendations for the management of patients with obstructive sleep apnoea and hypertension. Eur Respir J 2013; 41: 523–38.
50. Ageeva N.V. Sostoianie perifericheskoi gemodinamiki, mikrotsirkuliatsii i reologicheskikh svoistv krovi u bol'nykh semeinoi giperkholesterinemiei pri medikamentoznom i ekstrakorporal'nom metodakh lecheniia. Avtoref. dis. … kand. med. nauk. M., 1998. [in Russian]
51. Zubieta-Calleja GR, Paulev PE, Zubieta-Calleja L et al. Altitude adaptation through hematocrit changes. J Physiol Pharmacol 2007.
Авторы
Т.Д.Бугаев, Е.М.Елфимова, Н.В.Агеева, А.Б.Добровольский, А.Ю.Литвин*
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*alelitvin@yandex.ru
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*alelitvin@yandex.ru
Институт клинической кардиологии им. А.Л.Мясникова ФГБУ Российский кардиологический научно-производственный комплекс Минздрава России. 121552, Россия, Москва, ул. 3-я Черепковская, д. 15а
*alelitvin@yandex.ru
________________________________________________
A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
*alelitvin@yandex.ru
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