Snoring and obstructive sleep apnea syndrome as a factor in decreasing patient longevity

Background. The impact of obstructive sleep apnea syndrome on the cardiovascular system includes a negative impact on blood pressure, cardiac myocardial remodeling, and the progression of arterial atherosclerosis in patients. All these factors contribute to the earlier development and progression of cardiovascular diseases, including arterial hypertension.
Results. Existing data on the impact of obstructive sleep apnea syndrome in patients with various comorbid conditions allow us to draw several conclusions. Sympathetic nervous system activation in obstructive sleep apnea syndrome significantly constricts blood vessels, increases blood pressure and heart rate, which significantly impacts vascular endothelial dysfunction and contributes to the development of hypertension, cardiac arrhythmias, and heart failure. CPAP (Continuous Positive Airway Pressure) therapy in patients with obstructive sleep apnea syndrome has convincingly demonstrated a life-saving effect based on the elimination of dominant cardiovascular risk factors. It has been determined that the main therapeutic measures currently used in the treatment of hypertension include lifestyle modification, dietary interventions, and the use of antihypertensive medications in various combinations. However, in the presence of concomitant obstructive sleep apnea syndrome in such patients, achieving optimal blood pressure without proper treatment of sleep-disordered breathing is extremely difficult, especially in patients with resistant hypertension. Therefore, treatments for sleep-disordered breathing should complement and be actively used in patients with hypertension and concomitant obstructive sleep apnea syndrome. CPAP therapy is one of the most effective treatments for moderate to severe obstructive sleep apnea syndrome.
Conclusion. In the Russian Federation, there are still few reliable, randomized, large-scale studies identifying patients with snoring and obstructive sleep apnea syndrome, monitoring the progression of the disease, and evaluating the effectiveness of treatment methods. This problem intersects with many specialties, including otolaryngology, internal medicine, cardiology, and neurology, and requires an interdisciplinary approach and further study.

1. Suurna M., Ishman S. Essential Sleep Medicine and Surgery. Chest. 2022, р. 10-12.

2. Buzunov R. V., Legeida I. V., Tsareva E. V. Snoring and obstructive sleep apnea syndrome in adults and children. Prakticheskoye rukovodstvo dlya vrachey. М., 2013, p. 128. (In Russ.)

3. Svistushkin V. M. The role of otorhinolaryngologist in solving snoring problems and obstructive sleep apnea syndrome. Consilium Medicum. 2015; 17 (10): 41-42. (In Russ.)

4. Guilleminault C., Stoohs R., Clerk A., Cetel M., Maistros P. A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest. 1993; 104: 781-787.

5. Drapkina O. M., Dubolazova Yu. V., Korneeva O. N. Cardiovascular Therapy and Prevention. 2017; 16 (3): 68-74. (In Russ.)

6. uzunov R. V. Obesity and obstructive sleep apnea syndrome: how to break a solid circle. Effektivnaya farmakoterapiya. 2020; 16 (2): 30-33. (In Russ.)

7. Li N.-F., Yao X.-G., Zhu J., et al. Higher levels of plasma TNF-alpha and neuropeptide Y in hypertensive patients with obstructive sleep apnea syndrome. Clin. Exp. Hypertens. 2010; 32: 54-60.

8. Tsioufis C., Kordalis A., Flessas D., et al. Pathophysiology of resistant hypertension: The role of sympathetic nervous system. Int. J. Hypertens. 2011; 2011: 416-642.

9. Duran-Cantolla J., Aizpuru F., Montserrat J. M., et al. Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: Randomised controlled trial. BMJ. 2010; 341: 5991.

10. Lozano L., Tovar J. L., Sampol G., et al. Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: A randomized, controlled trial. Hypertens. 2010; 28: 2161-2168.

11. Punjabi N. M., Caffo B. S., Goodwin J. L., et al. Sleep-disordered breathing and mortality: A prospective cohort study. PLoS Med. 2009; 6: 1-9.

12. Misnikova I. V., Kovaleva Yu. A. Sleep and metabolic disorders. Rossiiskii meditsinskii zhurnal. 2017; 22: 1641-1645. (In Russ)

13. Khayat R. N., Abraham W. T., Patt B., Roy M., et al. Cardiac effects of continuous and bilevel positive airway pressure for patients with heart failure and obstructive sleep apnea: A pilot study. Chest. 2008.

14. Dyugovskaya L., Lavie P., Lavie L. Increased adhesion molecules expression and production of reactive oxygen species in leukocytes of sleep apnea patients. Am. J. Respir. Crit. Care Med. 2002; 165: 934-939.