[Brain-derived neurotrophic factor in the acute and early recovery period of ischemic stroke: the role of nocturnal hypoxemia]. / Mozgovoi neirotroficheskii faktor pri ishemicheskom insul'te v ostrom i rannem vosstanovitel'nom periodakh: rol' nochnoi gipoksemii.

OBJECTIVE: To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of ischemic stroke (IS). MATERIAL AND METHODS: We enrolled 44 patients (27 men, 17 women), aged 18-85 years, in the acute phase of IS. At 3-month follow-up, 35 people were examined (21 men and 14 women). In the acute period, in addition to routine diagnostic procedures, respiratory monitoring was carried out, and the serum level of BDNF was measured by enzyme-linked immunosorbent assay. BDNF level was also evaluated at 3-month follow-up visit. Neurological status and its dynamics in the acute period of stroke were assessed as part of the clinical routine according to the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge. RESULTS: We found a direct correlation between the duration of hypoxemia with SpO2 less than 90% (r=0.327, p=0.035) and less than 85% (r=0.461, p=0.003) and BDNF level in the acute phase of IS. BDNF level in the acute period of IS was negatively correlated with the minimum saturation value (r=-0.328, p=0.034). There was a direct relationship between BDNF level in the early recovery period and the duration of hypoxemia with SpO2 less than 85% (r=-0.389, p=0.028). A regression model showed that BDNF level was associated with the minimum SpO2 level. No significant associations were found with indicators of sleep-disordered breathing severity, such as the apnea-hypopnea index and the oxygen desaturation index. CONCLUSION: The severity of nocturnal hypoxemia is associated with the increase in BDNF levels both in the acute and recovery periods of IS, regardless of the presence of concomitant breathing disorders during sleep.

MTNR1A and MTNR1B Gene Variants of the Melatonin Receptor and Arterial Stiffness in Persons without Arterial Hypertension.

A comparative analysis of vascular stiffness indices and the results of blood test was carried out in 85 healthy donors aged 19-64 years, carriers of polymorphic variants of type 1 and type 2 melatonin receptor genes. The associations of polymorphic markers of type 1 MTNR1A (rs34532313) and type 2 MTNR1B (rs10830963) melatonin receptor genes with parameters of vascular stiffness and blood parameters in healthy patients were studied. Genotyping was performed using allele-specific PCR. In all patients, 24-h BP monitoring with assessment of arterial stiffness was performed. Allele C homozygotes of MTNR1A differed significantly from carriers of the major T allele by elevated triglyceride, LDL, and fibrinogen levels. The major allele C of the rs10830963 polymorphic variant of the MTNR1B gene is associated with elevated LDL and triglycerides, as well as with individual differences in the elastic properties of the vascular wall in the examined subjects.

[Brain damage in sleep-disordered breathing: the role of glia (clinical aspects)]. / Povrezhdenie golovnogo mozga pri rasstroistvakh dykhaniya vo sne: rol' glii (klinicheskie aspekty).

Sleep-disordered breathing (SDB) is one of the most frequent sleep-wake disorders. SDB is associated with brain damage that manifests as structural (atrophy of amygdala, hippocampus, insula) and functional (cognitive and emotional dysfunction) disorders. In this review, we summarize the results of clinical and experimental studies investigating the approach for the decreasing brain damage in SDB via glial modulation. In conclusion, we suggest the strategies for future research aimed at optimizing diagnostics and treatment of brain damage in SDB.

[Brain damage in sleep-disordered breathing: the role of glia]. / Povrezhdenie golovnogo mozga pri narusheniyakh dykhaniya vo sne: rol' glii.

Sleep-disordered breathing (SDB) is one of the most prevalent sleep-wake disorders and is associated with brain damage. In this review, we describe the role of astroglia, microglia and oligodendroglia as the main cellular mediators of brain damage in SDB based on the results of experimental studies. Specifically, we describe the role of the molecules that are expressed by glia and mediate oxidative stress (NADPH-oxidase), inflammation (hypoxia-inducible factor-1, inducible nitric oxide synthase, pro- and anti-inflammatory cytokines) and sympathetic hyperactivation (ATP, lactate).

[Sleep-wake cycle regularity and cardiometabolic indicators]. / Regulyarnost' ritma «son ­ bodrstvovanie¼ i kardiometabolicheskie pokazateli.

OBJECTIVE: To evaluate the association between sleep-wake rhythm and cardiometabolic parameters. MATERIAL AND METHODS: 103 participants, aged 25-64 years, underwent actigraphy study with Actigraph Actilife GT3X + device (USA) for 7 days. We assessed actigraphy indicators (physical activity and sleep data), anthropometric indicators, blood pressure and laboratory parameters. Actigraphy data was processed using the nparACT package in the R program with the calculation of nonparametric indicators: intraday variability, interday stability, the average level of lowest activity for five hours (L5) and ten hours with the highest activity (M10), relative amplitude is the ratio of M10/L5. RESULTS: The nonparametric analysis showed an association of the higher night activity with sleep effectiveness, wake after sleep onset, indicators of physical activity. A more stable sleep pattern is associated with more steps, less weight and waist circumference, lower levels of diastolic blood pressure, creatinine and insulin. Increased fragmentation of sleep patterns is associated with increased CRP and increased sedentary time. Participants with higher activity contrast have less waist circumference, hips and body mass index, lower levels of CRP and insulin. CONCLUSIONS: Rhythm and quality of sleep are important parameters associated with cardiometabolic indicators. Stable sleep patterns, higher activity during the day and lower night activity are associated with a more favorable condition of cardiovascular system.

[Sleep disordered breathing in patients with chronic heart failure: prognosis and management]. / Narusheniya dykhaniya vo vremya sna u patsientov s khronicheskoi serdechnoi nedostatochnost'yu: prognoz i vozmozhnosti terapii.

Sleep disordered breathing is a frequent comorbidity (50-75%) in patients with chronic heart failure, but it is usually underestimated. This review analyzes sleep disordered breathing in patients with chronic heart failure, demonstrates pathogenetic relationships and the prognostic role of sleep apnea. The authors present modern treatment options for sleep apnea in this cohort (from non-invasive ventilation to implantable devices), highlight the role of drug therapy and outline perspectives of different treatment approaches. This clinical problem is designated as multidisciplinary, which requires a dialogue between researchers and doctors of various specialties to organize comprehensive effective care for this cohort of patients.

[Multifunctional Monitoring: is it Possible to Simultaneously Evaluate Blood Pressure and Sleep-Disordered Breathing?]

Objective Carry out a comparative assessment of respiratory performance, based on multifunctional monitoring (MFM) and the recommended practice for complete polysomnography (PSG), and evaluate the effect of the blood pressure (BP) measurements in MFM on the quality of sleep.Materials and Methods At the first stage, 22 healthy volunteers (control group) underwent concomitant PSG and MFM, and 14 patients with suspected sleep-disordered breathing (SDB) underwent only PSG. At the second stage, concomitant PSG and MFM were performed in patients with confirmed SDB.Results In the control group, MFM detected a lower level of SpO2, a lower desaturation index (DI), and a higher apnea index (AI) than in the PSG group. However, the apnea-hypopnea index (AHI) was comparable in both groups. During concomitant PSG-MFM, the measurements of BP increased the number of micro-arousals only in the SDB group.Conclusion Results of the assessment of respiratory performance in MFM are comparable in both groups. The detected features of MFM indicators in the evaluation of the chest movements using rheopneumography, criteria different from that generally used for desaturation and hypoxemia, can lead to underestimation of desaturation and DI and underestimation of AI in the control group. The measurements of BP during sleep induced micro-arousals in the SDB group.

[Obstructive sleep apnea syndrome and cognitive impairment]. / Cindrom obstruktivnogo apnoé sna i kognitivnye narusheniia.

Sleep-disordered breathing is associated with sleep fragmentation and reduced blood oxygenation due to apnea and hypopnea episodes. Multiple studies indicate that obstructive sleep apnea syndrome (OSAS) can have negative impact on cognitive functioning, primarily executive functions, attention, and episodic memory. The attention is also focused on cognition in patients with neurologic and psychiatric comorbidities. There are different explanatory models, which show the mechanisms of OSAS influence on cognition. However, it is still unclear how the initial severity of the disease and clinical outcomes interrelate, and which factors play role in the compensation of cognitive dysfunction. Better understanding of these issues is crucial for the prevention of cognitive impairment and rehabilitation of cognitive functioning.

Psychometric properties of the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS).

Insufficient sleep could severely impair both cognitive and learning skills. More prominent changes are found in children and adolescents. Tools used to estimate sleepiness in the adult population are commonly inappropriate for children. The objective of our study was to provide a reliable instrument to measure excessive sleepiness for upcoming studies in Russian-speaking children, applying the Russian version of Pediatric Daytime Sleepiness Scale (PDSS). The following tasks were resolved in our study: translation, validation, and analysis of psychometric properties of the Russian adaptation of the PDSS by standard tests. After the semantic validation of the instrument through a multi-stage translation process we checked its psychometric validation. A total of 552 students, consisting of N = 285 for the exploratory factor analysis (EFA), N = 267 for the confirmatory factor analysis (CFA) and N = 204 for test-retest analysis of public elementary schools located in Northern Russia completed the PDSS and Munich Chronotype Questionnaire to estimate sleep parameters in the classroom during the lessons. Response rate was 90%; excluded cases contained no data. Further, 204 of our participants completed the PDSS in a 3 months interval to check the test-retest reliability. Internal consistency was measured by Cronbach's alpha coefficients and CFA was used to test factorial validity of the tool. Concurrent validity and test-retest reliability were assessed via intra-class coefficient. Internal consistency of the PDSS scale was high (Cronbach's α = 0.8). The construct validity of the PDSS was supported by CFA (factor loadings were from 0.438 to 0.727) and the test-retest reliability demonstrated by the intra-class coefficient was 0.70. The total PDSS score was independent of sex. The mean total value of PDSS was 11.95 ± 6.24. Higher scores on PDSS were negatively correlated with sleep duration. Thus, the construct validity of the instrument remains valid and could be used for Russian-speaking youth samples in the evaluation of daytime sleepiness. It could be useful in future applications by sleep scientists and health practitioners.

[Sleep disorders and stroke: data of the esse-rf study]. / Narusheniia sna i insul't: dannye issledovaniia ÉSSE-RF.

AIM: To assess the association between stroke and self-reported sleep disorders in the epidemiological studies of cardiovascular diseases in various regions of Russia (ESSE-RF). MATERIAL AND METHODS: A questionnaire survey included unorganized male and female population, aged 25 to 64 years, from 13 regions of the Russian Federation. In the analysis, answers to the question related to history of stroke: 'Did the doctor ever tell you that you had / had the following diseases?' (the 'Diseases' module) were included. The authors also evaluated answers about sleep duration, insomnia complaints, and sleepiness (the 'Sleep assessment' module). RESULTS AND CONCLUSION: Of 20 357 respondents, 422 (2%) confirmed the history of stroke. Both short and long sleep duration were not associated with stroke. Complaints of sleep disorders (snoring, sleep apnea, difficulty falling and maintaining sleep, as well as their combinations) were more frequently correlated with stroke. After adjustment for gender, age, body mass index, office blood pressure, the regression analysis showed that odds ratio was not significant for all complaints, except the combination of sleep apnea with frequent daytime sleepiness (1.7 (95% CI 1.04-2.8) (p=0.034). Therefore, symptoms of sleep-disordered breathing and insomnia are more common in respondents with the history of stroke. The combination of sleep apnea and frequent sleepiness complaints may indicate more severe sleep disorders in post-stroke patients.

[Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study]. / Sotsial'no-demograficheskie aspekty insomnii v rossiiskoi populiatsii po dannym issledovaniia ÉSSE-RF.

AIM: To estimate the prevalence of insomnia symptoms and their association with socio-demographic characteristics in the regions participated in the study. MATERIAL AND METHODS: Data from participants of the cohort study Epidemiology of cardiovascular disease in various regions of the Russian Federation (ESSE-RF), aged 25-64 years, from 13 regions of the Russian Federation were analyzed. They were interviewed about sleep complaints: difficulties falling asleep, maintaining sleep, sleepiness and sleeping pill intake (response variants: never, less than once a week, 1-2 times a week, three and more times a week). Responses with complaints occurring at least three times a week were considered as insomnia symptoms. Social and demographics characteristics from survey included: age, gender, education, marital status, job/employment, type of housing. The final analysis included 20 359 respondents. RESULTS: Clinically significant frequent (≥3 times a week) difficulties of falling asleep were reported by 17.2% respondents, difficulties in maintaining sleep by 13.6%; drowsiness by 6.3%, taking sleeping pills by 2.9% respondents. Women reported sleep complaints twice more after comared to men. The occurrence of frequent difficulties to falling asleep and nocturnal awakenings increased with age - from 11.4% and 5.9% to 24.2% and 20.7%. The highest occurrence of insomnia symptoms to such as difficulties in falling asleep and nocturnal awakenings was found in women, older age groups, divorced subjects or living separately, those with primary education, retired or disabled and living in a communal apartment or 'other' type of housing. CONCLUSION: Symptoms of insomnia are widespread among participants of the ESSE-RF study and associated with socio-demographic characteristics. Groups with high risk of insomnia include women, older age groups, divorced or living separately, those with primary education, unemployed pensioners and people with disabilities living in a communal apartment or 'other' type of housing.

[Stress levels and coping behavior in patients with chronic insomnia]. / Uroven' stressa i stress-preodolevaiushchee povedenie u patsientov s khronicheskoi insomniei.

AIM: To assess stress level and coping strategies in chronic insomnia as its potential psychological factors. MATERIAL AND METHODS: The study group included 29 patients (19 women), aged 18-55 years old (mean age 33.1±2.1 years), with chronic insomnia diagnosed in accordance with the International Classification of Sleep Disorders III. The control group was formed by 32 subjects (11 men), aged 18-55 years old (mean age 31.5±2.0 years), without sleep disorders. Insomnia Severity Index and polysomnography were used to evaluate sleep quality. Stress level and coping strategies were assessed via an interview (stressfull life events during last year, their duration, their controllability, unexpectedness, and outcome), and by 'Level of subjective control' and 'Ways of coping questionnaires'. RESULTS: Both groups were comparable by the mean number of significant events during last year (4.97±0.34 vs 4.72±0.23, p=0.54). Patients with insomnia more often reported the loss of a relative (p=0.04), while controls more frequently reported positive events, such as pregnancy (p=0.007) or wedding (p=0.02) among close ones. Insomniacs more often described the stressful events as uncontrolled (p<0.001) and prolonged (p<0.001). They demonstrated lower indices of all the scales of the 'Level of subjective control', questionnaire except the scale of interpersonal attitudes. They rarely implemented confrontive coping (p=0.001), seeking social support (p<0.001), accepting responsibility (p<0.001) and positive reappraisal (p<0.001). CONCLUSIONS: The interpretation of stressful events and personal response in insomnia patients might be considered as psychological risk factors for insomnia development.

[The role of subjective methods for the evaluation of sleep quality]. / Opredelenie roli sub''ektivnykh metodov obsledovaniia v otsenke kachestvennykh kharakteristik sna.

AIM: To assess the accuracy of questions evaluating the quality and duration of sleep. MATERIAL AND METHODS: Target population included residents of St. Petersburg, who participated in the epidemiological study ESSE-RF. Out of 1417 participants, 136 individuals agreed to undergo additional sleep evaluation, and 49 subjects underwent polysomnography study for objective sleep evaluation. All participants were interviewed for subjective sleep assessment (standard questionnaires and Pittsburgh sleep quality index questionnaire). RESULTS: One third of the participants evaluated sleep quality in the lab worse than at home. Their sleep duration was 1,5h shorter than in those who reported sleep quality to be as good as at home. However, the majority of participants slept in the sleep lab more than at home for the previous month. Moreover, 59% subjects reported sleep disturbances. Sleep duration during night in the lab was 6.6 [3; 9] - vs. 7 [3; 10] hours as assessed by PSG and by subjective report, respectively (p=0,06). At the same time, usual average sleep duration was 8 [5; 10] hours (p=0.005), and average sleep duration during last month - 7 [5; 9] hours. CONCLUSION: One third of subjects report worse sleep in the laboratory compared to the usual nights and it is associated with their subjective shorter sleep duration. Subjective assessment of sleep duration and sleep onset time is appropriate for sleep evaluation during the last night, unlike subjective assessment of awakenings after sleep onset. Average self-reported sleep duration depends on the question formulation.

[Use of physiological reparation regulators in glaucoma surgery: a clinicoimmunological study].

The paper presents the comparative results of clinical and immunological studies dealing with the use of the physiological reparation regulators (the human amniotic membrane and systemic enzyme therapy) and the antimetabolite 5-fluorouracil (5-FU) to prevent excessive ocular tissue scarring. The clinical observations have demonstrated the high efficiency of the proposed methods for the physiological regulation of reparative processes as compared with the use of 5-FU, which manifested as a more marked normalization ofophthalmotonus and fewer numbers of postoperative complications. The investigation of the study of proliferation-activating cytokine (TGF-beta1) and antiprolerative cytokine (IFN-gamma) has demonstrated the immunomodulating properties of the physiological reparation regulators used in the present study.

[Medico-economic effectiveness of dispensary care for patients with chronic nonspecific lung diseases in a rural locality]. / Mediko-ékonomicheskaia éffektivnost' dispanserizatii bol'nykh khronicheskimi nespetsificheskimi zabolevaniiami legkikh v usloviiakh sel'skoi mestnosti.

Dispensarization of rural patients with chronic nonspecific lung diseases by means of available methods of diagnosis and treatment and with regard to the disease entity and course made it possible to reduce 1.7-fold the rate of temporary disability and thus to save 19.386 roubles.