[Obstructive respiration disorders during sleep and disorders of cardiac rhythm]. / Obsruktivnye narusheniia dykhaniia vo vremia sna i narusheniia serdechnogo ritma.

AIM: To investigate the impact of obstructive sleep apnoea (OSA) on circadian profile of cardiac arrhythmia in patients with ischemic heart disease (IHD) and to determine clinical markers of OSA. MATERIAL AND METHODS: 52 patients (31 males, 21 females, body mass index 30.5 +/- 5.8 kg/m2) with IHD admitted to hospital for ventricular extrasystole and paroxysmal cardiac fibrillation filled in questionnaires, were examined anthropometrically, with nocturnal cardiorespiration and holter monitoring. Cluster and correlation-regression mathematical analyses of the findings were made. RESULTS: OSA was detected in 42 (80.8%) patients. Patients with primarily nocturnal arrhythmia, compared to those with diurnal arrhythmia had a significantly higher index apnea/hypopnea (29.2 and 21.5 vs 4.4, respectively), more pronounced fall in saturation (12.9 and 9.4% vs 4.9%, respectively) and lower body mass index. In 12 (23%) patients arrhythmia arose in parallel with episodes of sleep apnea/hypopnea. Mathematical analysis determined the following clinical markers of sleep respiratory disorders: regular intensive nocturnal snoring, body mass index > 25 kg/m2 and diurnal drowsiness > 15 scores by Epworth scale. CONCLUSION: ORDS may provoke cardiac arrhythmia in patients with IHD.

[Placebo-controlled study of short-term hypotensive effect of intranasal ventilation with continuous positive pressure upper respiratory tract therapy in patients with stage I arterial hypertension]. / Placebo-kontroliruemoe issledovanie kratkosrochnogo gipotenzivnogo éffekta intranazal'noi ventiliatsii s postoiannym polozhitel'nym davleniem v verkhnikh dykhatel'nykh putiakh u bol'nykh arterialnoi gipertoniei I stadii.

AIM: To compare a short-term hypotensive effect of intranasal ventilation with continuous positive airway pressure (CPAP-therapy) in patients with arterial hypertension stage I and placebo-control patients. MATERIAL AND METHODS: The CPAP-therapy and placebo-control groups consisted of 12 young men with arterial hypertension (AH) stage I. They were matched by age, body mass index, smoking habits, arterial pressure 24-h monitoring (APM) and night cardiorespiratory monitoring. Patients of the treatment group received CPAP-therapy (REMstar Choice, Respironics, USA) followed by repeated APM. Patients of the placebo group used a nasal mask without turning on the apparatus. Then a repeated APM was performed. RESULTS: As shown by improved APM data, CPAP-therapy was effective in AH stage I. Positive response was the greatest for systolic and diastolic hypertensive load. CONCLUSION: The above results may serve as an argument in support of a positive relation between elevated resistance of the upper respiratory airways in sleep and systemic AH.

[State of the upper respiratory tract in patients with stage I arterial hypertension]. / Sostoianie verkhnikh dykhatel'nykh putei u patsientov s arterial'noi gipertoniei I stadii.

AIM: To study morphofunctional features of the upper airways (UAW) in wakeful patients (juveniles with arterial hypertension stage I) and genetic predisposition to UAW obstruction in sleeping patients. MATERIAL AND METHODS: The examination of 18 juveniles with arterial hypertension stage I and II normotensive juveniles included measurements of body mass index (BMI), circumference of the neck (CN), conduction of lateral cephalometry, MR imaging of UAW tissues, evaluation of nasal breathing, smoking habits and collection of family disease history. All the patients were examined by otorhinolaryngologist. RESULTS: Hypertensive juveniles appeared to have significantly higher values of BMI, CN, ANB, NAPg angles, distance between the hyoid bone and the mandible, anteroposterior tongue length in lateral projection, less values of SNPg angle (p < 0.05). Relatives of hypertensive juveniles had significantly greater prevalence of hypertension, snoring and their combination. CONCLUSION: In arterial hypertension there are some anatomofunctional grounds to UAW resistance in sleep. In addition to hereditary predisposition to hypertension, this may underlie development of wakeful systemic hypertension.

[Obstructive sleep apnea in patients with stage I arterial hypertension]. / Obstruktsiia verkhnikh dykhatel'nykh putei vo vremia sna u bol'nykh s arterial'noi gipertoniei I stepeni.

AIM: To study sleep breathing in young men with arterial hypertension stage I. MATERIAL AND METHODS: Somnological history, night cardiorespiratory monitoring, 24-h monitoring of arterial pressure (AP) and ECG were analysed in 34 young men with arterial hypertension (AH) of the first degree and 12 normotensive young men. RESULTS: Hypertensive young men had a higher index apnea/hypopnea, mean duration of apnea/hypopnea (p < 0.05), maximal desaturation (p < 0.1), indirect parameters of inspiratory apnea, they snored more and woke up in sleep more frequently, their night hypertension was more than daytime. This was observed even in patients with overweight. CONCLUSION: All hypertensive young men examined had indirect signs of obstructive sleep apnea. The triggering role in it of the lungs and subclinical obstruction of upper airways in AH is suggested.

[Respiratory sleep disorders in patients with congestive heart failure]. / Narusheniia dykhaniia vo vremia sna u patsientov s zastoinoi serdechnoi nedostatochnost'iu.

AIM: To examine respiration in sleeping patients with congestive heart failure (CHF). MATERIAL AND METHODS: Night cardiorespiratory monitoring was made in 30 CHF patients with coronary heart disease (CHD), arterial hypertension and dilated cardiomyopathy. The control group consisted of 16 patients with obstructive sleep apnea and hypopnea (OSAH) free of CHF. RESULTS: Respiratory sleep disorders were registered in all the examinees. Moderate and severe OSAH occurred more often. CHF patients vs controls had shorter inhalation, expiration, overall duration of the respiratory cycle, higher rate of the respiratory movements. With aggravation of the respiratory disorders in sleeping CHF patients, minute ventilation, respiratory volume and mean inspiratory flow arose. In severe OSAH there was low functional residual lung capacity and high intraalveolar volume in end expiration positive pressure. The above changes may cause fatigue and weakness of the respiratory muscles and alter intracardiac hemodynamics. CONCLUSION: For CHF patients it is recommended to perform CPAP-therapy in sleep.

[The cardiological manifestations of the obstructive sleep apnea syndrome. Clinical cases]. / Kardiologicheskie proiavleniia sindroma obstruktivnogo apnoé vo vremia sna. Klinicheskie sluchai.

Two cases of sick sinus syndrome with asystole in patients with obstructive sleep apnea syndrome are reported. Management of such patients using CPAP therapy is detailed. The apnea symptoms and somnological history are important in evaluation of the condition of patients with sleep cardiac arrhythmia especially in patients with day sleepiness, night snore and obesity.

[Pharmacologic effects of peripheral vasodilators in patients with secondary pulmonary hypertension]. / Farmakologicheskie éffekty perifericheskikh vazodilatatorov u bo'lnykh so vtorichnoi legochnoi gipertenziei.

A single dose of capoten (25 mg) and prazosin (I mg) was given to 82 patients with stable pulmonary hypertension and chronic non-specific pulmonary diseases and to 34 patients with the above condition and arterial hypertension. Systolic and diastolic pressure in the system of the pulmonary artery and total pulmonary and total peripheral resistance were decreased; capoten exhibited more pronounced hypotensive effect. Unidirectional changes were revealed in the course treatment. Combined use of capoten, prazosin and euphilline produced the additional hypotensive effect on pulmonary circulation. Capoten and prazosin had no direct broncholytic effect.

[Intravenous laser therapy in multimodal treatment of acute pneumonia]. / Vnutrivennaia lazeroterapiia v kompleksnom lechenii ostrykh pnevmonii.

Such therapy has been administered to 70 patients with acute pneumonias. 25 patients on traditional therapy have made up the reference group. The effects of laser therapy on the clinical picture, status of the coagulation system cellular and plasma factors, fibrinolysis, and on the blood stream at the site of the pneumonic involvement have been examined in the patients with acute pneumonias in single tests and after a course of treatment. Intravenous laser therapy has had a favourable effect on the clinical course of acute pneumonias, accelerating the terms of pneumonia resolution and promoting and earlier and more complete restoration of the blood stream and normalization of the hemostasis, in contrast to routine therapy.