КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ СУТОЧНОГО МОНИТОРИРОВАНИЯ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ И ЦИРКАДНОГО СИНТЕЗА МЕЛАТОНИНА В ПРОГНОЗИРОВАНИИ СИНДРОМА ОБСТРУКТИВНОГО АПНОЭ СНА У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ I-II СТЕПЕНИ

Abstract

Objective. To study the role of 24-hour ambulatory blood pressure monitoring (ABPM) and circadian melatonin (MT) synthesis in predicting obstructive sleep apnea syndrome (OSAS) in patients with grade 1-2 arterial hypertension (AH) and to reveal the relationship between the study findings. Material and methods. 67 patients aged 50.0 (41.0; 56.0) having grade 1-2 AH were examined and divided into 2 groups in regard to the complex of clinical and instrumental research methods: Group 1 – 25 patients having AH and Group – 45 patients having AH associated with OSAS. 24-hour ABPM, anthropometric measurements, and respiratory monitoring were performed. MT levels were evaluated by the content of its metabolite 6-sulfatoxymelatonin (6-COMT) in the urine. Results It has been found that according to ABPM diastolic blood pressure variability during the day was ≥12 mm Hg and had high sensitivity (74.1%) and specificity (91.7%) for predicting the OSAS in patients with hypertension receiving standard antihypertensive therapy. The characteristic feature of the daily MT production in patients with AH in combination with OSAS is an increase in the level of 6-SOMT in daily urine (p=0.031) and its daily portion (p=0.037), correlating with the severity of OSAS (r=0.43; p=0.00065 and r=0.40; p=0.00079, respectively) and independent of the grade of AH (p>0.05). Conclusion. The obtained results allow us to recommend the use of ABPM as a screening, low-cost study to predict OSAS in patients with grade 1-2 AH. The identified changes in the daily rhythm of MT synthesis weakly correlate with the severity of OSAS and the degree of hypertension.