Soltani R. Sleep apnea syndrome: pathogenesis and clinical features of transformation of functional disorders into somatic pathology (clinical and experimental study)

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a pathological condition of night sleep disturbances due to inspiratory airway obstruction of various origins and a pause in respiration for more than 15 seconds with subsequent micro-awakenings, as a result of which patients do not sleep at night, and have pathological excessive day time sleepiness. A whole symptom complex of secondary functional changes is formed in the body, which causes the development of somatic pathology (neurological, cardiovascular, respiratory, etc.). A comprehensive psychosomatic study of the central and autonomic nervous systems in patients with OSAHS has been carried out. It has been established that as a result of insomnia disorders, patients get a symptom complex of deteriorating quality of life. When tested on the Hamilton Anxiety Rating Scale (HAM-A), firstly applied to the patients with OSAHS, it was found that against the background of poor sleep at night and pathological daytime sleepiness, patients develop “symptomatic anxiety”. It has been established that in patients with OSAHS there is a shift of autonomic balance towards the predominance of the parasympathetic nervous system, against which during episodes of apnea-hypopnea the sympathetic-adrenal system is excessively activated, which leads to autonomic imbalance. The method of complex non-invasive study of hemodynamics and oxygen balance was optimized, on the basis of which adaptive reorganization of the respiratory center was revealed in patients with OSAHS, which is manifested by a decrease in its sensitivity to critical blood gas composition; hemodynamic system, which is manifested by an increase in both cardiac output and an increase in total peripheral vascular resistance; blood system, manifested by secondary polycythemia syndrome. It is has been determined that such features of the body’s compensatory response to nocturnal episodes of hypoxia and hypercapnia contribute to the formation of the phenomenon of central sleep apnea in patients with obstructive apnea; development of hypertension; microcirculation disorders and organ damage; increased risk of thrombogenic complications. An experimental model of obstructive sleep apnea-hypopnea syndrome was first developed; simultaneously, the peculiarities of changes in intrapleural pressure, behavioral reactions, vegetative status and massometric characteristics of the heart of animals were studied.