Фенотип сочетания хронической обструктивной болезни легких и апноэ сна – синдрома перекреста

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.

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