Синдром обструктивного апноэ сна в континууме неконтролируемого течения артериальной гипертонии

Цель. Изучить частоту и степень тяжести нарушений дыхания во время сна у больных с неконтролируемой артериальной гипертонией (АГ) среди пациентов, направленных на диагностику в лабораторию сна.

Материалы и методы. Включено 113 пациентов 18-80-ти лет с АГ. Всем больным проведено ночное кардиореспираторное мониторирование, общеклиническая и лабораторно-инструментальная диагностика. За неконтролируемое течение АГ было принято превышение уровня систолического артериального давления (АД) >140 мм рт. ст. или диастолического АД >90 мм рт. ст. на фоне постоянного приема антигипертензивной терапии (АГТ) – по данным как минимум двух из трех измерений на приеме у врача в лаборатории сна.

Результаты. Среди всех больных с неконтролируемым течением АГ (группа 1; n=42, 37,2%) у 95,2% был выявлен синдром обструктивного апноэ сна (СОАС). В сравнении с группой с контролируемой АГ (группа 2), индекс апноэ/гипопноэ (ИАГ) и индекс десатурации (ИД) были выше в группе 1 (ИАГ 28,0 соб./ч [14,8; 51,8] против 17,5 соб./ч [8,7; 39,0], р=0,03; ИД 25,3 соб./ч [14,4; 50,6] против 17,1 соб./ч [8,5; 37,0], p=0,04). Кроме того, данные показатели оказались маркерами неконтролируемого течения АГ (ИАГ >19,9 соб./ч, AUC=0,62, p=0,03; ОШ 3,23, 95%; ДИ 1,7-6,1, p=0,00; ИД >19,5 соб./ч, AUC=0,62, p=0,03; ОШ 3,07, 95% ДИ 1,7-5,7, p=0,01). В свою очередь, уровень систолического АД >146 мм рт. ст. оказался маркером наличия СОАС средней или тяжелой степени (AUC=0,66, p=0,00; ОШ 4,45, 95% ДИ 1,8-11,2, p=0,00).

Заключение. Высокая частота СОАС преимущественно средней или тяжелой степени у пациентов с неконтролируемой АГ подчеркивает важность обследования данной группы больных в лаборатории сна. Вероятно, своевременное выявление и лечение СОАС позволит лучше контролировать уровень АД и, таким образом, снизит общий сердечно-сосудистый риск.

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