ПРОГНОСТИЧЕСКАЯ РОЛЬ ПАРАМЕТРОВ ДЫХАНИЯ В РАЗВИТИИ АРИТМИЙ У ПАЦИЕНТОВ С СИНДРОМОМ ОБСТРУКТИВНОГО НОЧНОГО АПНОЭ И ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract

Abstract. Obstructive sleep apnea syndrome (OSAS) is increasingly being considered as a factor associated with the development of nocturnal arrhythmias, as well as an increased risk of sudden cardiac death. The prevalence of OSA reaches 5-7% in the adult population. The prognostic role of pathological breathing patterns has not been sufficiently investigated, and therefore further study of the pathogenesis of arrhythmias for the subsequent intensification of therapeutic measures is promising. Aim of the Research. To study the prognostic significance of individual breathing parameters in different sleep phases for the development of atrial fibrillation and ventricular arrhythmias in patients with obstructive sleep apnea syndrome (OSAS) and chronic heart failure (CHF) with preserved ejection fraction (EF). Materials and methods. 86 men with moderate and severe OSAS (with an apnea/hypopnea index (AHI) >15 per hour) were examined. To diagnose OSAS, all patients underwent a polysomnographic study of night sleep. The severity of obstructive respiratory disorders during sleep was assessed by the apnea/hypopnea index for the total period of sleeping. Using polysomnography, we additionally investigated the following parameters of respiratory disturbances during the night sleep period: index of obstructive apnea/hypopnea selectively in REM sleep (AHIobsREM); index of respiratory distress syndrome for the entire period of sleep (IRDS); index of respiratory distress syndrome in the REM sleep phase (IRDS REM); average saturation per night; desaturation index for the total period of sleep; desaturation index in REM sleep. The observation period was 12 months, during which the presence of atrial fibrillation paroxysms lasting more than 30 s and the development of high-grade ventricular arrhythmias (III-V class according to Ryan) were assessed. Results. In the course of the study, a number of breathing parameters during the night time sleep (IAHobs, IAHobsREM, IRDS, IRDS REM) significantly correlated with the development of the studied cardiac arrhythmias. The most significant prognostic role has been stated for obstructive sleep apnea registered in the REM sleep phase. Conclusion. Breathing parameters during nighttime sleeping (IAHobs, IAHobs REM, IRDS, IRDS REM), which characterize the severity of OSAS are independent predictors of the development of paroxysmal atrial fibrillation and high-grade ventricular extrasystole in patients with OSAS and CHF with preserved EF. The results obtained make it possible to use these sleep parameters in the future in stratifying the risk of arrhythmias and determining treatment tactics in this cohort of patients.