medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-064medsovet-7437Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESСиндром ожирения – гиповентиляцииObesity – hypoventilation syndromehttps://orcid.org/0000-0002-4726-4906НуралиеваГ. С.NuralievaG. S.

Нуралиева Галиа Сериковна - кандидат медицинских наук, доцент кафедры пульмонологии, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности, НИИ пульмонологии ФМБА.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 115682, Москва, Ореховый бульвар, д. 28

Galiya S. Nuralieva - Cand. Sci. (Med.), Associate Professor, Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Researcher, Laboratory of Intensive Therapy and Respiratory Failure, Research Institute for Pulmonology of the Federal Medical Biological Agency.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Orekhovy Boulevard, Moscow, 115682

galia32@yandex.ruhttps://orcid.org/0000-0002-6658-0963БодунковМ. В.BodunkovM. V.

Бодунков Михаил Валерьевич - студент.

119021, Москва, ул. Россолимо, д. 11, стр. 2

Mikhail V. Bodunkov - Student, Sklifosovsky Institute of Clinical Medicine of I.M. Sechenov First Moscow State Medical University (Sechenov University).

11, Bldg. 2, Rossolimo St., Moscow, 119021

Mi.Bodunkov@yandex.ruhttps://orcid.org/0000-0003-0343-3728БикбаувК. И.BikbauvK. I.

Бикбаув Кирилл Ильмирович - студент.

119021, Москва, ул. Россолимо, д. 11, стр. 2

Kirill I. Bikbauv - Student, Sklifosovsky Institute of Clinical Medicine of I.M. Sechenov First Moscow State Medical University (Sechenov University).

11, Bldg. 2, Rossolimo St., Moscow, 119021

developer1240@gmail.ruhttps://orcid.org/0000-0001-6060-9342СамойловЕ. A.SamoilovE. A.

Самойлов Евгений Анатольевич - студент.

119021, Москва, ул. Россолимо, д. 11, стр. 2

Evgenii A. Samoilov - Student, Sklifosovsky Institute of Clinical Medicine of I.M. Sechenov First Moscow State Medical University (Sechenov University).

11, Bldg. 2, Rossolimo St., Moscow, 119021

zhenya.samoylov7@gmail.comhttps://orcid.org/0000-0001-9357-4924ЦареваН. А.TsarevaN. A.

Царева Наталья Анатольевна - кандидат медицинских наук, доцент кафедры пульмонологии, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); научный сотрудник лаборатории интенсивной терапии и дыхательной недостаточности, НИИ пульмонологии ФМБА.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 115682, Москва, Ореховый бульвар, д. 28

Natalya A. Tsareva - Cand. Sci. (Med.), Associate Professor, Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Researcher, Laboratory of Intensive Therapy and Respiratory Failure, Research Institute for Pulmonology of the Federal Medical Biological Agency.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Orekhovy Boulevard, Moscow, 115682

n_tsareva@mail.ruhttps://orcid.org/0000-0002-0685-4133ТрушенкоН. В.TrushenkoN. V.

Трушенко Наталья Владимировна - кандидат медицинских наук, ассистент кафедры пульмонологии, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); научный сотрудник клинической лаборатории, НИИ пульмонологии ФМБА.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 115682, Москва, Ореховый бульвар, д. 28

Natalia V. Trushenko - Cand. Sci. (Med.), Аssistant of the Pulmonology Department, Sechenov First Moscow State Medical University (Sechenov University); Researcher, Laboratory of Intensive Therapy and Respiratory Failure, Research Institute for Pulmonology of the Federal Medical Biological Agency.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Orekhovy Boulevard, Moscow, 115682

trushenko.natalia@yandex.ruhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич - академик РАН, доктор медицинских наук, профессор, заведующий кафедрой пульмонологии, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); руководитель клинического отдела, НИИ пульмонологии ФМБА.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 115682, Москва, Ореховый бульвар, д. 28

Sergey N. Avdeev - Academician RAS, Dr. Sci. (Med.), Professor, Head of Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University); Head of the Clinical Department, Research Institute for Pulmonology of the Federal Medical Biological Agency.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Orekhovy Boulevard, Moscow, 115682

serg_avdeev@list.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Научно-исследовательский институт пульмонологии Федерального медико-биологического агентстваРоссияSechenov First Moscow State Medical University (Sechenov University); Research Institute for Pulmonology of the Federal Medical Biological AgencyRussian FederationИнститут клинической медицины имени Н.В. Склифосовского Первого Московского государственного медицинского университета имени И.М. Сеченова (Сеченовский Университет)РоссияSklifosovsky Institute of Clinical Medicine of I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation202313042023043542Copyright © Нуралиева Г.С., Бодунков М.В., Бикбаув К.И., Самойлов Е.A., Царева Н.А., Трушенко Н.В., Авдеев С.Н., 20232023Нуралиева Г.С., Бодунков М.В., Бикбаув К.И., Самойлов Е.A., Царева Н.А., Трушенко Н.В., Авдеев С.Н.Nuralieva G.S., Bodunkov M.V., Bikbauv K.I., Samoilov E.A., Tsareva N.A., Trushenko N.V., Avdeev S.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7437

Ожирение – это быстрорастущая социальная проблема, которой подвержены более 650 млн человек по всему миру. Доказано, что ожирение связано с сахарным диабетом, дислипидемией, гипертонией, сердечно-сосудистыми заболеваниями, синдромом обструктивного апноэ сна (СОАС). Однако одним из наиболее серьезных и наименее освещенных осложнений является синдром ожирения – гиповентиляции, характеризующийся ожирением (индекс массы тела ≥ 30 кг/м2), гиперкапнией (PaСО2 > 45 мм рт. ст.), а также нарушением дыхания во время сна (AHI > 5 ч). Распространенность СОГ оценивается в 10–20% у пациентов с ожирением. Основу патогенеза СОГ составляет низкий комплаенс грудной клетки и легких из-за избыточной нагрузки массой. Действенным методом лечения является изменение образа жизни с целью снижения массы тела, однако нередки случаи возникновения острой дыхательной недостаточности (ОДН), для коррекции которой необходима респираторная поддержка, в частности с помощью неинвазивной вентиляции легких (НВЛ). Для этого применяют аппараты искусственной вентиляции легких (ИВЛ) с различными режимами работы: положительное давление только на вдохе (CPAP-терапия), давление различного уровня на вдохе и выдохе (BiPAP-терапия), поддержка давлением среднего гарантированного объема вдоха (AVAPS). При этом к главным причинам СОГ не относят обструктивные явления, из-за чего CPAP-терапия концептуально не является методом лечения СОГ, однако было выяснено, что более 90% пациентов с СОГ имеют сопутствующий СОАС. У таких пациентов большинство патофизиологических звеньев могут быть безопасно скорректированы с помощью CPAP-терапии, поскольку с помощью этого метода достигается стабильность просвета верхних дыхательных путей. Режимы BiPAP и AVAPS воздействуют на патогенетические механизмы СОГ, из-за чего демонстрируют высокую эффективность как в краткосрочной перспективе (купирование ОДН), так и в долгосрочной (длительное лечение респираторной поддержкой).

Obesity is a rapidly growing social problem that affects more than 650 million people worldwide. It has been proven that obesity is associated with diabetes mellitus, dyslipidemia, hypertension, cardiovascular diseases, obstructive sleep apnea (OSA) syndrome. However, one of the most serious and least reported complications is obesity-hypoventilation syndrome, characterized by obesity (body mass index ≥ 30 kg/m2), hypercapnia (PaCO2 > 45 mmHg), as well as respiratory disorders during sleep (AHI > 5h). The prevalence of OHS is estimated at 10–20% in obese patients. The basis of the pathogenesis of OHS is low compliance of the chest and lungs due to excessive weight load. An effective method of treatment is to change the life-style in order to reduce body weight, however, there are frequent cases of acute respiratory failure (ARF), for the correction of which respiratory support is necessary, in particular with the help of non-invasive ventilation (NVL). For this purpose, an artificial ventilation device is used with various modes of operation: continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), average volume-assured pressure support (AVAPS). At the same time, obstructive phenomena are not attributed to the main causes of OHS, which is why CPAP is not conceptually a method of treating OHS, however, it was found that more than 90% of patients with OHS have concomitant OSA. In such patients, most of the pathophysiological links can be safely corrected using CPAP therapy, since with this method the stability of the upper respiratory tract lumen is achieved. BiPAP and AVAPS regimens affect the pathogenetic mechanisms of OHS, which is why they demonstrate high effectiveness both in the short term (ARF) and in the long term (long-term treatment with respiratory support).

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