The state of the great arteries in type 2 diabetes mellitus patients with obstructive sleep apnea syndrome


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Aim. To evaluate the impact of hyperglycemia concurrent with obstructive sleep apnea syndrome (OSAS) on endothelial function (EF) and vessel remodeling in patients with Grade 1—2 hypertension. Subjects and methods. A total of 101 patients with Grade 1—2 hypertension were examined. A study group (SG) consisted of 74 hypertensive patients with type 2 diabetes mellitus (T2DM). A control group (CG) comprised 27 persons with isolated blood pressure (BP) elevation. The patients with T2DM underwent cardiorespiratory sleep monitoring, the readings of which were used to divide SG into 2 subgroups: 1) patients with an apnea-hypopnea index of <30 episodes/h (SG-1); 2) those with an index of >30 episodes/h (SG-2). 24-hour BP and vascular stiffness monitoring was made; EF was evaluated; common carotid artery diameter (CCAD) and intima-media thickness (IMT) were determined. Results. The diabetic patients showed lower central diastolic BP and higher aortic pulse BP. Unlike the comparison group, the diabetic patients with severe OSAS were found to have the highest central pulse wave propagation velocity at night. There was a preponderance of an average nocturnal arterial rigidity index, average daily and average nocturnal BP rising rates, and shorter reflected wave propagation time in the diabetic patients. The mean level of flow-mediated vasodilation was significantly reduced in SG-2. The diabetic patients, unlike the controls, were ascertained to have decreased absolute responsiveness index values. There were increases in IMT and CCAD in SG-2. Conclusion. OSAS worsens EF and vessel rigidity in patients with T2DM concurrent with hypertension.

References

  1. Glasser SP, Arnett DK, McVeigh GE, Gary E, Finkelstein SM, Bank AK. The importance of arterial compliance in cardiovascular drug therapy. J Clin Pharm. 1998;38(3):202-212.
  2. Lavie P, Herer P, Hoffstein V. Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. Br Med J. 2000;320:479-482.
  3. Peppard PE, Young T, Palta M, Scatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. New Eng J Med. 2000;342(19):1378-1384.
  4. Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB. Investigating the relationship between stroke and obstructive sleep apnea. Stroke. 1996;27(3):401-407.
  5. Peker Y, Kraiczi H, Hedner J, Löth S, Johansson A, Bende M. An independent association between obstructive sleep anoea and coronary artery disease. Eur Resp J. 1999;14(1):179-184.
  6. Kraiczi H, Caidahl K, Samuelsson A, Peker Y, Hedner J. Impairment of vascular endothelial function and left ventricular filling: association with the severity of apnea-induced hypoxemia during sleep. Chest. 2001;119(4):1085-1091.
  7. Lavie L. Obstructive sleep apnoea syndrome — an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35-51.
  8. Руководство пользователя ПО BPLab V. 3.2. Ч.1. 2010;149.
  9. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111-1115.
  10. Дзизинский А.А., Протасов К.В., Синкевич Д.А., Куклин С.Г. Среднесуточное пульсовое артериальное давление как маркер ремоделирования сосудов и миокарда у больных гипертонической болезнью. Бюллетень ВСНЦ СО РАМН. 2006;5:69-72.
  11. Кардиоваскулярная профилактика. Национальные рекомендации. Разработаны Комитетом экспертов Всероссийского научного общества кардиологов. Кардиоваскулярная терапия и профилактика. 2011;10:64 (Приложение 2).
  12. Соколов Е.И. Диабетическое сердце. М.: Медицина; 2002.
  13. Левин Я.И., Полуэктов М.Г. Сомнология и медицина сна. Избранные лекции. М.: Медфорум; 2013.
  14. Os I, Gudmundsdottir H, Kjeldsen SE, Oparil S. Treatment of isolated systolic hypertension in diabetes mellitus type 2. Diabetes Obes Metab. 2006;8(4):381-387.
  15. Ройтберг Г.Е. Метаболический синдром. М.: МЕДпресс-информ; 2007.
  16. Небиеридзе Д.В. Клиническое значение дисфункции эндотелия при артериальной гипертонии. Системные гипертензии. 2005;7(1):43-49.
  17. Bruno RM, Penno G, Daniele G. Type 2 diabetes mellitus worsens arterial stiffness in hypertensive patients through endothelial dysfunction. Diabetologia. 2012;55(6):1847-1855.
  18. Punjabi NM, Polotsky VY. Disorders of glucose metabolism in sleep apnea. J Appl Physiol. 2005;99(5):1998-2007.
  19. Касаткина С.Г., Касаткин С.Н. Значение дисфункции эндотелия у больных сахарным диабетом 2-го типа. Медицинские науки. 2011;7:248-252.
  20. Джахангиров Т.Ш. Сахарный диабет как проблема современной кардиологии. Кардиология. 2005;10:55-61.
  21. Кобалава Ж.Д., Котовская Ю.В., Моисеев В.С. Артериальная гипертония. Ключи к диагностике и лечению. М.: ГЭОТАР-Медиа; 2009.
  22. Steinke W, Els T, Hennerici M. Compensatory carotid artery dilatation in early atherosclerosis. Circulation. 1994;89(6):2578-2581.

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