References

systhiper

Системные гипертензии

Systemic Hypertension

2075-082X2542-2189

LLC «ИнтерМедсервис»

10.26442/2075082X.2020.4.200529

systhiper-614

Research Article

СТАТЬИ

ARTICLES

Приверженность ПАП-терапии у больных с синдромом обструктивного апноэ сна и сердечно-сосудистыми заболеваниями

PAP-therapy adherence in patients with obstructive sleep apnea and cardiovascular diseases

https://orcid.org/0000-0002-3609-2504

Михайлова

О. О.

Mikhailova

O. O.

alelitvin@yandex.ru

https://orcid.org/0000-0002-3140-5030

Елфимова

Е. М.

Elfimova

E. M.

alelitvin@yandex.ru

https://orcid.org/0000-0001-5918-9969

Литвин

А. Ю.

Litvin

A. Yu.

alelitvin@yandex.ru

https://orcid.org/0000-0002-9822-4357

Чазова

И. Е.

Chazova

I. E.

c34h@yandex.ru

Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава РоссииРоссияMyasnikov Institute of Clinical Cardiology, National Medical Research Center of CardiologyRussian Federation

Институт клинической кардиологии им. А.Л. Мясникова ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России; ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоРоссияMyasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology; Pirogov Russian National Research Medical UniversityRussian Federation

2020

23122022

1743743

2022

Михайлова О.О., Елфимова Е.М., Литвин А.Ю., Чазова И.Е.

Mikhailova O.O., Elfimova E.M., Litvin A.Y., Chazova I.E.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.syst-hypertension.ru/jour/article/view/614

Цель. Изучить длительную приверженность терапии положительным давлением в дыхательных путях (Positive Airway Pressure - ПАП-терапии) и ее влияние на характер течения различных сердечно-сосудистых заболеваний у больных с синдромом обструктивного апноэ сна. Материалы и методы. В исследование включены 119 пациентов, наблюдавшихся в ФГБУ «НМИЦ кардиологии» в период с 2012 по 2020 г., с синдромом обструктивного апноэ сна различной степени тяжести и сердечно-сосудистыми заболеваниями (ССЗ), получающих ПАП-терапию (из них 93 человека, 78,2%, - мужчины). Медиана продолжительности наблюдения составила 3,0 года [1,5; 5,0]. За критерии приверженности приняты следующие: использование ПАП-аппарата на протяжении не менее 71% ночей в год и не менее 4 ч за ночь. Результаты. В общей выборке больных с ССЗ 63,4% пациента привержены ПАП-терапии. Приверженные больные оказались старше по возрасту (64,0 года [58,5; 68,0] против 59,0 года [53,0; 65,0] соответственно, р=0,03) и имели более высокий индекс апноэ-гипопноэ - 47,7 соб/ч [37,5; 64,4] против 38,2 соб/ч [30,4; 52,7] соответственно, р=0,04. Пациенты с артериальной гипертонией (АГ) III стадии значимо меньше используют ПАП-аппарат каждую ночь в сравнении с больными АГ I-II стадии (3,4 ч за ночь [1,1; 3,6] против 6,3 ч за ночь [5,3; 7,4] соответственно, р=0,00). Приверженность больных при наличии или отсутствии ишемической болезни сердца и пароксизмальной формы фибрилляции предсердий не различалась. Значимого различия по частоте развития III стадии АГ, ишемической болезни сердца, перехода пароксизмальной формы фибрилляции предсердий в постоянную между группами приверженных и неприверженных ПАП-терапии не выявлено. Заключение. ПАП-терапии полностью привержены 63,4% больных с ССЗ. Приверженные лечению пациенты старше по возрасту и имеют более высокий индекс апноэ-гипопноэ. При наличии III стадии АГ приверженность ПАП-терапии ниже, чем при АГ меньших стадий. Характер течения различных ССЗ у приверженных и неприверженных пациентов не различался.

Materials and methods. The study included 119 patients with obstructive sleep apnea (OSA) and cardiovascular diseases (CVD) who were followed up at the National Medical Research Center of Cardiology of the Ministry of Health of the Russian Federation in the period from 2012 to 2020, and have been receiving positive airway pressure (PAP) therapy (93 men, 78.2%). The median follow-up was 3.0 years [1.5; 5.0]. The adherence criteria were the following: the usage of the PAP device for at least 71% of nights a year, and at least 4 hours per night. Results. 64.3% of patients met the criteria for adherence to PAP therapy (use more than 4 hours/night, more than 71% of nights). The adherent patients were older (64.0 years [58.5; 68.0] versus 59.0 years [53.0; 65.0] resp., p=0.03) and had a higher apnea-hypopnea index - AHI (47.7 events/h [37.5; 64.4] versus 38.2 events/h [30.4; 52.7] resp., p=0.04). Patients with stage III of hypertension were using a PAP device every night significantly less (3.4 h/night [1.1; 3.6] versus 6.3 h/night [5.3; 7.4] respectively, p=0.00) - in comparison with patients with hypertension stages I-II. The adherence of patients with or without coronary artery disease (CAD) and paroxysmal atrial fibrillation (AF) did not differ. There was no significant difference in the incidence of stage III hypertension, CAD, and permanent AF between the groups of adherent and non-adherent to PAP therapy patients. Conclusion. 63.4% of patients with CVD were adherent to PAP therapy. Adherent patients were older and had a higher AHI. Patients with stage III hypertension were worse adherent to PAP therapy in comparison with patients with hypertension of lesser stages. The CVDs course in adherent and non-adherent patients did not differ.

приверженность ПАП-терапиисиндром обструктивного апноэ сна

positive airway pressure therapy adherenceobstructive sleep apnea

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The authors declare that there are no conflicts of interest present.