russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2021-4314russjcardiol-4314Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВлияние отмены длительной СРАР-терапии на течение обструктивного апноэ снаEffect of withdrawing long-term CPAP therapy on the course of obstructive sleep apneahttps://orcid.org/0000-0002-4982-628XАгальцовМ. В.AgaltsovM. V.

Михаил Викторович Агальцов — кандидат медицинских наук, старший научный сотрудник отдела фундаментальных и прикладных аспектов ожирения.

Москва

Moscow

agaltsov@rambler.ruhttps://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Оксана Михайловна Драпкина — профессор, доктор медицинских наук, член-корр. РАН, руководитель отдела фундаментальных и прикладных аспектов ожирения, директор.

Москва

Moscow

drapkina@bk.ruФГБУ Национальный медицинский исследовательский центр терапии и профилактической медицины Минздрава РоссииРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian Federation202106072021262SОбразование43144314Copyright © Агальцов М.В., Драпкина О.М., 20212021Агальцов М.В., Драпкина О.М.Agaltsov M.V., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/4314Цель

Цель. Оценка влияния отмены СРАР-терапии после длительного лечения (12 мес.) на течение обструктивного апноэ сна (ОАС) у пациентов со средней и тяжелой степенью болезни.

Материал и методы

Материал и методы. В исследование были включены 40 пациентов со средней и тяжелой степенью ОАС и с пароксизмальной формой фибрилляции предсердий (ФП) после перенесенного хирургического лечения. Средний возраст обследуемых составил 59,3±8,2 лет, преобладали пациенты с ожирением (55%). Всем пациентам была подобрана и инициирована СРАР-терапия. Через 12 мес. у окончивших исследование пациентов СРАР-терапия была прервана, через 1-2 дня после прерывания лечения было проведено повторное кардиореспираторное мониторирование сна для оценки степени тяжести нарушений дыхания во сне.

Результаты

Результаты. Отмена СРАР-терапии во всех наблюдаемых случаях привела к немедленному рецидиву ОАС. Хотя среднее значение индекса апноэ/гипопноэ (ИАГ) снизилось с 24 эп/ч [20; 34] до лечения до 21 эп/ч [13; 27] после, статистически значимой разницы до и после терапии не отмечено. При статистическом анализе обследованной группы был зарегистрирован переход более тяжелых степеней болезни к более легким в зависимости от исходной степени тяжести ОАС. Корреляционный анализ показал, что существуют статистически значимые взаимосвязи степени тяжести болезни, конечного значения ИАГ и минимального значения кислорода и массы тела пациентов (до и после терапии) (r=0,396, 0,411 и -0,488; r=0,358, 0,398 и -0,44, соответственно, р<0,05).

Заключение

Заключение. В нашем исследовании при прерывании терапии после 12 мес. использования СРАР полного излечения от нарушений дыхания во сне не зарегистрировано ни в одном случае. ОАС рецидивировало сразу после отмены СРАР-терапии (на 1-2 день). Тяжесть рецидива заболевания зависела от исходной степени тяжести болезни. На настоящее время продолжение СРАР-терапии остается единственной возможностью достижения полного контроля за ОАС как за фактором риска развития ФП.

Aim

Aim. To assess the effect of withdrawing long-term (12 months) CPAP therapy on the course of obstructive sleep apnea (OSA) in patients with moderate to severe disease.

Material and methods

Material and methods. The study included 40 patients with moderate to severe OSA and paroxysmal atrial fibrillation (AF) after surgical treatment. The mean age of the subjects was 59,3+8,2 years. In addition, 55% of patients had obesity. All patients were started on CPAP therapy. After 12 months, CPAP therapy was canceled in the patients who completed the study. Additional cardiorespiratory sleep monitoring was performed 1-2 days after the withdrawal of treatment to assess the severity of sleep-related breathing disorders.

Results

Results. Cancellation of CPAP therapy in all observed cases led to an immediate relapse of OSA. Although the mean value of the apnea/hypopnea index (AHI) decreased from 24 episodes per hour [20; 34] before treatment up to 21 episodes per hour [13; 27] after 12-month CPAP therapy, there was no significant difference before and after therapy. In addition, the statistical analysis showed a transition from more severe OSA degrees to moderate ones, depending on the initial severity of the disease. Correlation analysis demonstrated significant relationships of the OSA severity, the final AHI value and the minimum oxygen level with the patient’s body weight (before and after therapy) (r=0,396, 0,411 and -0,488; r=0,358, 0,398 and -0,44, respectively, p<0,05).

Conclusion

Conclusion. In our study, when the 12-month CPAP therapy was canceled, no complete cure for sleep-related breathing disorders was recorded in any case. OSA recurrence was recorded immediately after discontinuation of CPAP therapy (on days 1-2) and its severity depended on the initial severity of the disease. At present, the continuation of CPAP therapy remains the only way to achieve complete control of OSA as a risk factor for AF.

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The authors declare that there are no conflicts of interest present.