Связь обструктивного апноэ сна и сердечно-сосудистых заболеваний с позиций доказательной медицины. Часть 1

Проанализированы результаты проспективных исследований, метаанализов и систематических обзоров, посвященных ассоциациям обструктивного апноэ сна (ОАС) с различными сердечнососудистыми заболеваниями (ССЗ). В настоящее время достигнуто понимание широкой распространенности нарушений дыхания во сне среди общей популяции экономически развитых стран, показан рост числа заболевших ОАС при динамическом наблюдении. Взаимосвязь между ОАС и ССЗ нашла широкое подтверждение в больших когортных исследованиях. В первой части обзора рассматривается связь артериальной гипертензии (АГ) и различных форм сердечных аритмий: фибрилляции предсердий (ФП), брадиаритмий, желудочковой экстрасистолии, в т.ч.  внезапной смерти во сне, с обструктивными нарушениями дыхания во сне. Эти группы сердечно-сосудистых нозологий в настоящее время демонстрируют наиболее доказанную взаимосвязь с апноэ сна. Помимо одномоментных исследований, свидетельствующих о широкой распространенности ОАС у  пациентов с  АГ и  ФП, часть наблюдательных исследований говорит о росте числа пациентов с АГ и с пароксизмальной формой ФП, имевших нелеченое апноэ сна. Отдельно анализируются современные тенденции выделения фенотипически разных форм ОАС (в частности, REM-зависимое апноэ сна при АГ) из имеющихся баз данных, как определение наиболее неблагоприятных факторов, влияющих на кардиоваскулярную систему.

1. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine. 2014; doi:10.1378/chest.14-0970.

2. Peppard PE, Young T, Barnet JH, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006-14. doi:10.1093/aje/kws342.

3. Young T, Palta M, Dempsey J, et al. The occurrence of sleepdisordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-5. doi:10.1056/NEJM199304293281704.

4. Punjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. Proc Am Thor Soc. 2008;5:136-43. doi:10.1513/pats.200709-155MG.

5. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleepdisordered breathing in the general population: the Hypno Laus study. Lancet Respir Med. 2015;3:310-8. doi:10.1016/S2213-2600(15)00043-0.

6. Jennum P, Riha RL. Epidemiology of sleep apnoea/hypopnoea syndrome and sleep-disordered breathing. EurRespir J. 2009;33:907-14. doi:10.1183/09031936.00180108.

7. Tilkian AG, Guilleminault C, Schroeder J, et al. Sleep-induced apnea syndrome. Prevalence of cardiac arrhythmias and their reversal after tracheostomy. Am J Med. 1977;63(3):348-58. doi:10.1016/0002-9343(77)90272-8.

8. Guilleminault C, Connolly SJ, Winkle RA. Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome. Am J Cardiol. 1983;52:490-4. doi:10.1016/0002-9149(83)90013-9.

9. Koskenvuo M, Partinen M, Sarna S, et al. Snoring as a risk factor for hypertension and angina pectoris. Lancet. 1985;1:893-6. doi:10.1016/s0140-6736(85)91672-1.

10. Peppard PE, Young T, Palta M, et al. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378-84. doi:10.1056/NEJM200005113421901.

11. Punjabi NM, Caffo BS, Goodwin JL, et al. Sleep- Disordered Breathing and Mortality: A Prospective Cohort Study. PLoSMed. 2009;6:e1000132. doi:10.1371/journal.pmed.1000132.

12. Gottlieb DJ, Yenokyan G, Newman AB, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122:352-60. doi:10.1161/CIRCULATIONAHA.109.901801.

13. Javaheri S, Blackwell T, Ancoli-Israel S, et al. Sleep-disordered breathing and incident of heart failure in older men. Am J Respir Crit Care Med. 2016;193:561-8. doi:10.1164/rccm.201503-0536OC.

14. Baguet JP, Levy P, Barone-Rochette G, et al. Masked hypertension in obstructive sleep apnea syndrome. J Hypertens. 2008;26:885- 92. doi:10.1097/HJH.0b013e3282f55049.

15. Gonçalves SC, Martinez D, Gus M, et al. Obstructive sleep apnea and resistant hypertension: a case-control study. Chest. 2007;132:1858-62. doi:10.1378/chest.07-1170.

16. Logan AG, Perlikowski SM, Mente A, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens. 2001;19:2271-7. doi:10.1097/00004872-200112000-00022.

17. Calandra-Buonaura G, Provini F, Guaraldi P, et al. Cardiovascular autonomic dysfunctions and sleep disorders. Sleep Med Rev. 2016;26:43-56. doi:10.1016/j.smrv.2015.05.005.

18. 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. doi:10.1183/09031936.00226711.

19. Young T, Peppard P, Palta M, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997;157:1746-52.

20. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large communitybased study. Sleep Heart Health Study. JAMA. 2000;283:1829-36. doi:10.1001/jama.283.14.1829

21. Haas DC, Foster GL, Nieto FJ, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005;111:614-21. doi:10.1161/01.CIR.0000154540.62381.CF.

22. Bixler EO, Vgontzas AN, Lin HM, et al. Association of hypertension and sleep-disordered breathing. Arch Intern Med. 2000;160:2289- 95. doi:10.1001/archinte.160.15.2289.

23. Glasser M, Bailey N, McMillan A, et al. Sleep apnoea in older people. Breathe 2011 7: 248-256; doi:10.1183/20734735.021910.

24. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. BMJ. 2000;320:479-82. doi:10.1136/bmj.320.7233.479.

25. Tkacova R, McNicholas WT, Javorsky M, et al. Nocturnal intermittent hypoxia predicts prevalent hypertension in the European Sleep Apnoea Database cohort study. Eur Respir J. 2014;44:931 doi:10.1183/09031936.00225113.

26. Marin JM, Agusti A, VillarI, et al. Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA. 2012;307:2169-76. doi:10.1001/jama.2012.3418.

27. O’Connor GT, Caffo B, Newman AB, et al. Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study. Am J Respir Crit Care Med. 2009;179:1159-64. doi:10.1164/rccm.200712-1809OC.

28. Cano-Pumarega I, Duran-Cantolla J, Aizpuru F, et al. Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort. Am J Respir Crit Care Med. 2011;184:1299-304. doi:10.1164/rccm.201101-0130OC.

29. Mokhlesi B, Finn L A, Hagen E W, et al. Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort. Am J Respir Crit Care Med. 2014;190:1158-67. doi:10.1164/rccm.201406-1136OC.

30. Appleton SL, Vakulin A, Martin SA, et al. Hypertension Is Associated With Undiagnosed OSA During Rapid Eye Movement Sleep. Ches.t 2016;150:495-505. doi:10.1016/j.chest.2016.03.010.

31. Van Ryswyk E, Mukherjee S, Chai-Coetzer CL, et al. Sleep Disorders, Including Sleep Apnea, and Hypertension. Am J Hypertens. 2018;31:857-64. doi:10.1093/ajh/hpy082.

32. Genta PR, Drager LF, Lorenzi Filho G. Screening for Obstructive Sleep Apnea in Patients with Atrial Fibrillation. Sleep Med Clin. 2017;12:99-105. doi:10.1016/j.jsmc.2016.10.009.

33. 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;173:910-6. doi:10.1164/rccm.200509-1442OC.

34. Costa LE, Uchôa CH, Harmon RR, et al. Potential underdiagnosis of obstructive sleep apnoea in the cardiology outpatient setting. Heart. 2015;101:1288-92. doi:10.1136/heartjnl-2014-307276.

35. Linz D, McEvoy RD, Cowie MR, et al. Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review. JAMA Cardiol. 2018;3:532-40. doi:10.1001/jamacardio.2018.0095.

36. May AM, Van Wagoner DR, Mehra R. OSA and Cardiac Arrhythmogenesis: Mechanistic Insights. Chest. 2017;151:225-41. doi:10.1016/j.chest.2016.09.014.

37. Dempsey JA, Veasey SC, Morgan BJ, et al. Pathophysiology of sleep apnea. Physiol Rev. 2010;90:47-112. doi:10.1152/physrev.00043.2008.

38. Patel N, Donahue C, Shenoy A, et al. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol. 2017;228:967-70. doi:10.1016/j.ijcard.2016.11.137.

39. Mooe T, Gullsby S, Rabben T, et al. Sleep-disordered breathing: a novel predictor of atrial fibrillation after coronary artery bypass surgery. Coron Artery Dis. 1996;7:475-8.

40. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154-9. doi:10.1161/01.cir.97.21.2154.

41. Stevenson IH, Teichtahl H, Cunnington D, et al. Prevalence of sleep disordered breathing in paroxysmal and persistent atrial fibrillation patients with normal left ventricular function. Eur Heart J. 2008;29:1662-9. doi:10.1093/eurheartj/ehn214.

42. Zhao E, Chen S, Du Y, et al. Association between Sleep Apnea Hypopnea Syndrome and the Risk of Atrial Fibrillation: A MetaAnalysis of Cohort Study. Biomed Res Int. 2018;52:158-68. doi:10.1155/2018/5215868.

43. Youssef I, Kamran H, Yacoub M, et al. Obstructive Sleep Apnea as a Risk Factor for Atrial Fibrillation: A Meta-Analysis. J Sleep Disord Ther. 2018;7(1):282. doi:10.4172/2167-0277.1000282.

44. Gami AS, Hodge DO, Herges RM, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49:565-71. doi:10.1016/j.jacc.2006.08.060.

45. Ng CY, Liu T, Shehata M, et al. Meta-analysis of obstructive sleep apnea as predictor of atrial fibrillation recurrence after catheter ablation. Am J Cardiol. 2011;108:47-51. doi:10.1016/j.amjcard.2011.02.343.

46. Rossi VA, Stradling JR, Kohler M. Effects of obstructive sleep apnoea on heart rhythm. Eur Respir J. 2013;41:1439-51. doi:10.1183/09031936.00128412.

47. Maeno K, Kasai A, Setsuda M, et al. Advanced atrioventricular block induced by obstructive sleep apnea before oxygen desaturation. Heart Vessels. 2009;24:236-40. doi:10.1007/s00380-008-1113-2.

48. Koshino Y, Satoh M, Katayose Y, et al. Association of SleepDisordered Breathing and Ventricular Arrhythmias in Patients Without Heart Failure. Am J Cardiol. 2008;101:882-6. doi:10.1016/j.amjcard.2007.10.056.

49. Baranchuk A. Sleep apnea, cardiac arrhythmias, and conduction disorders. J Electrocardiol. 2012;45:508-12. doi:10.1016/j.jelectrocard.2012.03.003.

50. Cioffi G, Russo TE, Stefenelli C, et al. Severe obstructive sleep apnea elicits concentric left ventricular geometry. J Hypertens. 2010;28:1074-82. doi:10.1097/hjh.0b013e328336c90a.

51. Gami AS, Howard DE, Olson EJ, et al. Day-night pattern of sudden death in obstructive sleep apnea. N Engl J Med. 2005;352:1206- 14. doi:10.1056/NEJMoa041832.

52. Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013;62:610-6. doi:10.1016/j.jacc.2013.04.080.