PP.08.03] SLEEP BREATHING DISORDERS AS A KEY DETERMINANT FOR DEVELOPMENT OF UNCONTROLLED ARTERIAL HYPERTENSION

Abstract

Objective: The purpose of this study is to investigate the role of sleep disordered breathing, particularly obstructive sleep apnea-hypopnea syndrome (OSAS) in inadequate control of blood pressure in patients with arterial hypertension (AH). Design and method: 72 patients with AH (mean age 48.0 ± 11.2y) and regular antihypertensive treatment, as a monotherapy or combined treatment have been included in the given study. All patients have had apnea-hypopnea index (AHI) values > = 5.0 episode/hour according to the polysomnographic investigation. Men (n = 64) and patients with severe OSAS (AHI > = 30.0 episode/hour) have prevailed in the study population (88.9% and 79.2%, respectively). Results: 48 (66.7%) patients with OSAS and antihypertensive treatment have had uncontrolled and different severity degrees of AH in the moment of investigation. Meanwhile the I, II and III degrees of AH have been stated in 29.2%, 22.2% and 15.3% of cases respectively. It is noteworthy that antihypertensive treatment parameters characterizing drug quantity and doses, their pharmacological groups and combinations have been equivalent for both groups of patients with controlled and uncontrolled AH, therefore couldn’t motivate the fact for insufficient control of AH. In this view uncontrolled AH has been revealed in 73.7% of patients with severe OSAS (AHI) > = 30.0 episode/hour), while the same ratio has been only 40.0% for groups of patients with mild or moderate OSAS. It should be noted that OSAS conditioned micro- and macro-arousals induced by the apnea-hypopnea episodes, sleep fragmentation and changes of its structure, including impaired relations between «slow-wave» and «rapid-wave» different stages lead to the significant changes of sympathetic-parasympathetic equilibrium, which, by itself, can suppose additional difficulties in AH drug control. Conclusions: The two-third of patients with OSAS, despite of the presence of combined antihypertensive treatment, has had high blood pressure levels. Thus severity of OSAS can be considered as a key predictor for manifestation of uncontrolled AH.