DOI 10.34014/2227-1848-2020-2-21-30

24-HOUR BLOOD PRESSURE PROFILE IN CHRONIC CEREBROV ASCULAR DISEASES AND SLEEP-DISORDERED BREATHING

L.A. Geraskina1, G.G. Sharipov2, A.V. Fonyakin1, M.Yu. Maksimova1

1 Research Center of Neurology, Moscow, Russia;

2 Peoples’ Friendship University of Russia, Moscow, Russia

 

Arterial hypertension (AH) in patients with sleep-disordered breathing (SDB) is characterized by a higher level of blood pressure, increased variability and impaired circadian rhythm of blood pressure.

The goal of the paper is to establish the changes in 24-hour blood pressure profile in patients with chronic cerebrovascular diseases and sleep-disordered breathing to optimize antihypertensive therapy.

Materials and Methods. The trial enrolled 100 patients with chronic cerebrovascular diseases; the average age was 65 years (58.0; 74.5). Arterial hypertension was detected in 92 % of patients. All patients underwent 24-hour blood pressure monitoring. Cardiorespiratory monitoring was performed to verify sleep-disordered breathing. The authors also determined Apnea Hypopnea Index (AHI), saturation, and the duration of apnea episodes.

Results. Patients with moderate and severe sleep-disordered breathing (AHI≥15) demonstrated an increased systolic blood pressure (SBP) within 24 hours, an increased diastolic blood pressure (DBP) at night (p<0.05), as well as increased SBP and DBP variability at night. A decrease in circadian rhythm of blood pressure was observed in 65–70 % of patients, including 16 % of patients with increased night-time blood pressure. These changes correlated with the severity of sleep-disordered breathing (AHI), total desaturation duration and depth (p<0.05).

Conclusion. To increase the effectiveness of AH treatment and to control the target BP level in patients with chronic cerebrovascular diseases, it is necessary to find out whether patients suffer from sleep-disordered breathing, especially if night-time hypertension is detected.

Keywords: cerebrovascular diseases, 24-hour blood pressure monitoring, sleep-disordered breathing.

Conflict of interest. The authors declare no conflict of interest.

 

References

  1. Sharma S., Culebras A. Sleep apnea and stroke. Stroke Vasc. Neurol. 2016; 19 (1): 185–191. DOI: 10.1136/svn-2016-000038.

  2. Smol'yaninov S.V., Lyshova O.V., Kulakova A.A. Diagnostika i lechenie narusheniy dykhaniya vo sne u bol'nykh terapevticheskogo statsionara [Diagnosis and treatment of sleep breathing disorders in medical hospital patients]. Vestnik sovremennoy klinicheskoy meditsiny. 2017; 10 (4): 64–68. DOI: 10.20969/VSKM.2017.10(4).64-68 (in Russian).

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  4. Nieto F.J., Young T.B., Lind B.K. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000; 283 (14): 1829–1836. DOI: 10.1001/jama.283.14.1829.

  5. Parati G., Di Rienzo M., Bonsignore M.R. Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J. Hypertens. 1997; 15 (12 pt 2): 1621–1626. DOI: 10.1097/00004872-199715120-00063.

  6. Kohler M., Stradling J.R. Mechanisms of vascular damage in obstructive sleep apnea. Nat. Rev. Cardiol. 2010; 7 (12): 677–685. DOI: 10.1038/nrcardio.2010.145.

  7. Javaheri S., Barbe F., Campos-Rodriguez F. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J. Am. Coll. Cardiol. 2017; 69 (7): 841–858. DOI: 10.1016/j.jacc.2016.11.069.

  8. Ke X., Sun Y., Yang R. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17: 287. DOI: 10.1186/s12872-017-0723-y. PMID: 29212465.

  9. Berry R.B., Budhiraja R., Gottlieb D.J. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J. Clin. Sleep. Med. 2012; 8 (5): 597–619. DOI: 10.5664/jcsm.2172. PMID: 23066376.

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  11. Verdecchia P., Angeli F., Gattobigio R., Rapicetta C., Reboldi G. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am. J. Hypertens. 2007; 20 (2): 154–161. DOI: 10.1016/j.amjhyper.2006.07.017.

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  13. Shi J., Piao J., Liu B. Obstructive sleep apnea increases systolic and diastolic blood pressure variability in hypertensive patients. Blood Press Monit. 2017; 22 (4): 208–212. DOI: 10.1097/MBP.0000000000000259.

  14. Mansukhani M.P., Kara T., Caples S.M. Chemoreflexes, sleep apnea, and sympathetic dysregulations. Curr. Hypertens. Rep. 2014; 16 (9): 476. DOI: 10.1007/s11906-014-0476-2.

  15. Siennicki-Lantz A., Reinprecht F., Axelsson J., Elmstahl S. Cerebral Perfusion in the Elderly With Nocturnal Blood Pressure Fall. Eur. J. Neurol. 2007; 14 (7): 715–720. DOI: 10.1111/j.1468-1331.2007.01805.x. PMID: 17594325.

  16. Genta-Pereira D.C., Furlan S.F., Omote D.Q. Non-dipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring. Hypertension. 2018; 72 (4): 979–985. DOI: 10.1161/HYPERTENSIONAHA.118.11525. PMID: 30354706.

  17. Mamontov O.V., Sviryaev Yu.V., Kitalaeva K.T. Osobennosti avtonomnoy regulyatsii krovoobrashcheniya u bol'nykh arterial'noy gipertenziey s sindromom obstruktivnogo apnoe/gipopnoe vo sne [Autonomic circulatory control in patients with arterial hypertension and obstructive sleep apnea-hypopnea syndrome]. Arterial'naya gipertenziya. 2012; 18 (6): 560–568 (in Russian).

  18. Iftikhar I.H., Valentine C.W., Bittencourt L.R. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J. Hypertens. 2014; 32: 2341–2350. DOI: 10.1097/HJH.0000000000000372.

  19. Martinez-Garcia M.A., Capote F., Campos-Rodríguez F. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013; 310 (22): 2407–2415. DOI: 10.1016/j.sleep.2007.11.009. PMID: 18207454.

  20. Kuchmin A.N., Kazachenko A.A., Kulikov A.N. CPAP-terapiya – faktor zashchity serdechno-sosudistoy sistemy u patsientov s tyazheloy stepen'yu sindroma obstruktivnogo apnoe vo sne [CPAP-therapy as a protective cardiovascular factor in patients with severe obstructive sleep apnea syndrome]. Arterial'naya gipertenziya. 2017; 23 (4): 313–324. DOI: 10.18705/1607-419X-2017-23-4-313-324 (in Russian).

Received 18 April 2020; accepted 29 May 2020.

 

Information about the authors

Geraskina Lyudmila Aleksandrovna, Doctor of Sciences (Medicine), Leading Researcher, Cardiac Neurology Laboratory, 2nd Neurological Department, Research Center of Neurology. 125367, Russia, Moscow, Volokolamskoe Avenue, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1253-1082.

Sharipov Gayratdzhon Gufronovich, Post-graduate Student, Chair of Nervous Diseases and Neurosurgery named after Yu.S. Martynov, Peoples' Friendship University of Russia. 117198, Russia, Moscow, Miklukho-Maklay Street, 8; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9640-0900.

Fonyakin Andrey Viktorovich, Doctor of Sciences (Medicine), Professor, Leading Researcher, Head of Cardiac Neurology Laboratory, 2nd Neurological Department, Research Center of Neurology. 125367, Russia, Moscow, Volokolamskoe Avenue, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-5452-2152.

Maksimova Marina Yur'evna, Doctor of Sciences (Medicine), Professor, Head of the 2nd Neurological Department, Scientific Center of Neurology. 125367, Russia, Moscow, Volokolamskoe Avenue, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-7682-6672.

 

For citation

Geraskina L.A., Sharipov G.G., Fonyakin A.V., Maksimova M.Yu. Sutochnyy profil' arterial'nogo davleniya pri khronicheskikh tserebrovaskulyarnykh zabolevaniyakh i narushenii dykhaniya vo sne [24-hour blood pressure profile in chronic cerebrovascular diseases and sleep-disordered breathing]. Ul'yanovskiy mediko-biologicheskiy zhurnal. 2020; 2: 21–30. DOI: 10.34014/2227-1848-2020-2-21-30 (in Russian).

 

УДК 616.8-005:616-073.178:612.143:612.291

DOI 10.34014/2227-1848-2020-2-21-30

СУТОЧНЫЙ ПРОФИЛЬ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ ПРИ ХРОНИЧЕСКИХ ЦЕРЕБРОВАСКУЛЯРНЫХ ЗАБОЛЕВАНИЯХ И НАРУШЕНИИ ДЫХАНИЯ ВО СНЕ

Л.А. Гераскина1, Г.Г. Шарипов2, А.В. Фонякин1, М.Ю. Максимова1

1 ФГБНУ «Научный центр неврологии», г. Москва, Россия;

2 ФГАОУ ВО «Российский университет дружбы народов», г. Москва, Россия

 

Артериальная гипертония (АГ) у больных с нарушением дыхания во сне (НДС) характеризуется более высоким уровнем АД, повышенной вариабельностью и нарушением циркадного индекса (ЦИ) АД.

Цель – установить особенности изменений суточного профиля АД у больных хроническими цереброваскулярными заболеваниями (ЦВЗ) и НДС для оптимизации антигипертензивной терапии.

Материалы и методы. В исследование включено 100 пациентов с ЦВЗ, средний возраст – 65 (58,0; 74,5) лет. АГ выявлена у 92 % больных. Всем пациентам выполнено суточное мониторирование АД. НДС верифицировали методом кардиореспираторного мониторирования. Определяли индекс апноэ/гипопноэ (ИАГ), сатурацию и длительность эпизодов апноэ.

Результаты. При НДС умеренной и тяжелой степени (ИАГ≥15) выявлено повышение систолического АД (САД) в течение суток, диастолического АД (ДАД) ночью (p<0,05), а также повышенную вариабельность САД и ДАД в ночные часы, снижение ЦИ АД у 65–70 % больных, в т.ч. повышение АД ночью у 16 % больных. Эти изменения коррелировали с тяжестью НДС (ИАГ), суммарной длительностью и глубиной десатурации (р<0,05).

Выводы. Для повышения эффективности лечения АГ и контроля целевого уровня АД больных с хроническими ЦВЗ необходимо обследовать на наличие НДС, особенно при выявлении ночной гипертонии.

Ключевые слова: цереброваскулярные заболевания, суточное мониторирование артериального давления, нарушение дыхания во сне.

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

 

Литература

  1. Sharma S., Culebras A. Sleep apnea and stroke. Stroke Vasc. Neurol. 2016; 19 (1): 185–191. DOI: 10.1136/svn-2016-000038.

  2. Смольянинов С.В., Лышова О.В., Кулакова А.А. Диагностика и лечение нарушений дыхания во сне у больных терапевтического стационара. Вестник современной клинической медицины. 2017; 10 (4): 64–68. DOI: 10.20969/ VSKM.2017.10(4).64-68.

  3. Durán-Cantolla J., Aizpuru F., Montserrat J.M., Ballester E. Spanish Sleep and Breathing GroupContinuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ. 2010; 341: 5991. DOI: 10.1136/bmj.c5991. PMID: 21106625.

  4. Nieto F.J., Young T.B., Lind B.K. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. JAMA. 2000; 283 (14): 1829–1836. DOI: 10.1001/jama.283.14.1829.

  5. Parati G., Di Rienzo M., Bonsignore M.R. Autonomic cardiac regulation in obstructive sleep apnea syndrome: evidence from spontaneous baroreflex analysis during sleep. J. Hypertens. 1997; 15 (12 pt 2): 1621–1626. DOI: 10.1097/00004872-199715120-00063.

  6. Kohler M., Stradling J.R. Mechanisms of vascular damage in obstructive sleep apnea. Nat. Rev. Cardiol. 2010; 7 (12): 677–685. DOI: 10.1038/nrcardio.2010.145.

  7. Javaheri S., Barbe F., Campos-Rodriguez F. Sleep Apnea: Types, Mechanisms, and Clinical Cardiovascular Consequences. J. Am. Coll. Cardiol. 2017; 69 (7): 841–858. DOI: 10.1016/j.jacc.2016.11.069.

  8. Ke X., Sun Y., Yang R. Association of 24 h-systolic blood pressure variability and cardiovascular disease in patients with obstructive sleep apnea. BMC Cardiovasc. Disord. 2017; 17: 287. DOI: 10.1186/s12872-017-0723-y. PMID: 29212465.

  9. Berry R.B., Budhiraja R., Gottlieb D.J. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J. Clin. Sleep. Med. 2012; 8 (5): 597–619. DOI: 10.5664/jcsm.2172. PMID: 23066376.

  10. Кобалава Ж.Д., Котовская Ю.В. Мониторирование артериального давления: методические аспекты и клиническое значение. М.; 1999.

  11. Verdecchia P., Angeli F., Gattobigio R., Rapicetta C., Reboldi G. Impact of blood pressure variability on cardiac and cerebrovascular complications in hypertension. Am. J. Hypertens. 2007; 20 (2): 154–161. DOI: 10.1016/j.amjhyper.2006.07.017.

  12. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001; 358 (9287): 1033–1041. DOI: 10.1016/S0140-6736(01)06178-5.

  13. Shi J., Piao J., Liu B. Obstructive sleep apnea increases systolic and diastolic blood pressure variability in hypertensive patients. Blood Press Monit. 2017; 22 (4): 208–212. DOI: 10.1097/MBP.0000000000000259.

  14. Mansukhani M.P., Kara T., Caples S.M. Chemoreflexes, sleep apnea, and sympathetic dysregulations. Curr. Hypertens. Rep. 2014; 16 (9): 476. DOI: 10.1007/s11906-014-0476-2.

  15. Siennicki-Lantz A., Reinprecht F., Axelsson J., Elmstahl S. Cerebral Perfusion in the Elderly With Nocturnal Blood Pressure Fall. Eur. J. Neurol. 2007; 14 (7): 715–720. DOI: 10.1111/j.1468-1331.2007.01805.x. PMID: 17594325.

  16. Genta-Pereira D.C., Furlan S.F., Omote D.Q. Non-dipping Blood Pressure Patterns Predict Obstructive Sleep Apnea in Patients Undergoing Ambulatory Blood Pressure Monitoring. Hypertension. 2018; 72 (4): 979–985. DOI: 10.1161/HYPERTENSIONAHA.118.11525. PMID: 30354706.

  17. Мамонтов О.В., Свиряев Ю.В., Киталаева К.Т. Особенности автономной регуляции кровообращения у больных артериальной гипертензией с синдромом обструктивного апноэ/гипопноэ во сне. Артериальная гипертензия. 2012; 18 (6): 560–568.

  18. Iftikhar I.H., Valentine C.W., Bittencourt L.R. Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: a meta-analysis. J. Hypertens. 2014; 32: 2341–2350. DOI: 10.1097/HJH.0000000000000372.

  19. Martinez-Garcia M.A., Capote F., Campos-Rodríguez F. Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. JAMA. 2013; 310 (22): 2407–2415. DOI: 10.1016/j.sleep.2007.11.009. PMID: 18207454.

  20. Кучмин А.Н., Казаченко А.А., Куликов А.Н. CPAP-терапия – фактор защиты сердечно-сосудистой системы у пациентов с тяжелой степенью синдрома обструктивного апноэ во сне. Артериальная гипертензия. 2017; 23 (4): 313–324. DOI: 10.18705/1607-419X-2017-23-4-313-324.

Поступила в редакцию 18.04.2020; принята 29.05.2020.

 

Авторский коллектив

Гераскина Людмила Александровна – доктор медицинских наук, ведущий научный сотрудник лаборатории кардионеврологии 2-го неврологического отделения, ФГБНУ «Научный центр неврологии». 125367, Россия, г. Москва, Волоколамское шоссе, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-1253-1082.

Шарипов Гайратджон Гуфронович – аспирант кафедры нервных болезней и нейрохирургии им. Ю.С. Мартынова, ФГАОУ ВО «Российский университет дружбы народов». 117198, Россия, г. Москва, ул. Миклухо-Маклая, 8; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-9640-0900.

Фонякин Андрей Викторович – доктор медицинских наук, профессор, ведущий научный сотрудник, руководитель лаборатории кардионеврологии 2-го неврологического отделения, ФГБНУ «Научный центр неврологии». 125367, Россия, г. Москва, Волоколамское шоссе, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0001-5452-2152.

Максимова Марина Юрьевна – доктор медицинских наук, профессор, заведующая 2-м неврологическим отделением, ФГБНУ «Научный центр неврологии». 125367, Россия, г. Москва, Волоколамское шоссе, 80; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it., ORCID ID: https://orcid.org/0000-0002-7682-6672.

 

Образец цитирования

Гераскина Л.А., Шарипов Г.Г., Фонякин А.В., Максимова М.Ю. Суточный профиль артериального давления при хронических цереброваскулярных заболеваниях и нарушении дыхания во сне. Ульяновский медико-биологический журнал. 2020; 2: 21–30. DOI: 10.34014/2227-1848-2020-2-21-30.