medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2026-180medsovet-10272Research ArticleПРАКТИКАPRACTICEФенотип сочетания хронической обструктивной болезни легких и апноэ сна – синдрома перекрестаPhenotype of the combination of chronic obstructive pulmonary disease and sleep apnea – cross-over syndromehttps://orcid.org/0000-0002-0273-4388ПономареваИ. Б.PonomarevaI. B.

Пономарева Ирина Борисовна - к.м.н., доцент кафедры факультетской терапии имени профессора В.Я. Гармаша.

390026, Рязань, ул. Высоковольтная, д. 9; SPIN-код: 3984-1944

Irina B. Ponomareva - Cand. Sci. (Med.), Associate Professor of the Department of Faculty Therapy named after Professor V.Ya. Garmash.

9, Vysokovoltnaya St., Ryazan, 390013

docib@yandex.ruhttps://orcid.org/0000-0002-4445-4480ГлотовС. И.GlotovS. I.

Глотов Сергей Иванович - к.м.н., доцент, доцент кафедры факультетской терапии имени профессора В.Я. Гармаша.

390026, Рязань, ул. Высоковольтная, д. 9; SPIN-код: 7524-9816

Sergei I. Glotov - Cand. Sci. (Med.), Associate Professor, Associate Professor of the Faculty Therapy Department named after Professor V.Ya. Garmash.

9, Vysokovoltnaya St., Ryazan, 390013

sergeyglot@mail.ruhttps://orcid.org/0000-0001-8693-4696УрясьевО. М.UryasevO. M.

Урясьев Олег Михайлович - д.м.н., профессор, заведующий кафедрой факультетской терапии имени профессора В.Я. Гармаша.

390026, Рязань, ул. Высоковольтная, д. 9; SPIN-код: 7903-4609

Oleg M. Uryasev - Dr. Sci. (Med.), Professor, Head of the Department of Faculty Therapy named after Professor V.Ya. Garmash.

9, Vysokovoltnaya St., Ryazan, 390013

uryasev08@yandex.ruhttps://orcid.org/0000-0001-8264-6689КуликовС. А.KulikovS. A.

Куликов Сергей Алексеевич - ассистент кафедры факультетской терапии имени профессора В.Я. Гармаша.

390026, Рязань, ул. Высоковольтная, д. 9; SPIN-код: 4190-8127

Sergei А. Kulikov - Assistant Professor of the Department of Faculty Therapy named after V.Ya. Garmash.

9, Vysokovoltnaya St., Ryazan, 390013

kulikov_sergey88@mail.ruРязанский государственный медицинский университет имени академика И.П. ПавловаРоссияRyazan State Medical UniversityRussian Federation20261407202609241247Copyright © Пономарева И.Б., Глотов С.И., Урясьев О.М., Куликов С.А., 20262026Пономарева И.Б., Глотов С.И., Урясьев О.М., Куликов С.А.Ponomareva I.B., Glotov S.I., Uryasev O.M., Kulikov S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/10272

Хроническая обструктивная болезнь легких (ХОБЛ) и обструктивное апноэ во сне (ОАС) являются широко распространенными заболеваниями, а их сочетание называют синдромом перекреста (СП) и выделяют в отдельный фенотип. Физиологические нарушения, наблюдаемые во время сна у пациентов с ХОБЛ и ОАС, включают повышенное сопротивление верхних дыхательных путей, неэффективный газообмен и влияние на центральную регуляцию сна. Пациенты с СП подвержены большему риску возникновения фибрилляции предсердий, сердечно-сосудистых событий, в т. ч. фатальных (внезапной сердечно-сосудистой смерти), риску развития легочной гипертензии чаще, чем пациенты, имеющие только ХОБЛ или изолированное ОАС. В статье представлена патофизиология респираторных нарушений у пациентов с СП во время сна, данные эпидемиологических исследований, клинические последствия, факторы, влияющие на ассоциацию ХОБЛ с ОАС. Необходимым является применение скрининговых опросников с целью выявления пациентов для углубленной диагностики ОАС, также клиницисту следует обращать внимание на клинические признаки, определенные в качестве показаний для оценки возможных нарушений дыхания во сне при ХОБЛ. Лечение ОАС у пациентов с ХОБЛ может снизить сердечно-сосудистую смертность и улучшить выживаемость у этих пациентов. Терапия пациентов с СП предусматривает, наряду с изменением образа жизни, методы респираторной поддержки: дополнительную кислородотерапию, лечение методом создания постоянного положительного давления в дыхательных путях (CPAP), неинвазивную вентиляцию легких (НВЛ). В качестве препаратов медикаментозной терапии СП целесообразным может быть использование бронходилататоров и кортикостероидов.

Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are common diseases, and their combination is called overlap syndrome (OS) and is distinguished as a separate phenotype. Physiological disturbances observed during sleep in patients with COPD and OSA include increased upper airway resistance, ineffective gas exchange, and effects on central sleep regulation. Patients with OSA are at higher risk of atrial fibrillation, cardiovascular events, including fatal ones (sudden cardiovascular death), and the risk of developing pulmonary hypertension more often than patients with COPD alone or isolated OSA. The article presents the pathophysiology of respiratory disturbances in patients with OSA during sleep, epidemiological studies, clinical implications, and factors influencing the association of COPD with OSA. It is necessary to use screening questionnaires to identify patients for in-depth diagnostics of OSA, and the clinician should also pay attention to clinical signs defined as indications for the assessment of possible sleep-disordered breathing in COPD. Treatment of OSA in patients with COPD can reduce cardiovascular mortality and improve survival in these patients. Therapy for patients with OS, along with lifestyle changes, includes respiratory support methods: supplemental oxygen therapy, treatment with continuous positive airway pressure (CPAP), non-invasive ventilation (NIV). Bronchodilators and corticosteroids may be appropriate as drugs for drug therapy of SP.

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