High sleep reactivity: clinical, psychological and polysomnographic features

Background. The model of sleep reactivity to stress considers sleep reactivity to stress as a link in the pathogenesis of insomnia disorder – the degree to which stress disturbs sleep, which manifests as difficulty in initiating and maintaining sleep.The aim. To study clinical and psychological features as well as subjective and objective sleep indexes of subjects with high level of sleep reactivity to stress.Materials and methods. The psychological status, subjective indexes of sleep and sleep reactivity to stress according to Ford Insomnia Response to Stress Test were studied among 18–75 year-old subjects without significant sleep disturbances and patients with chronic insomnia. Polysomnography was performed for objective evaluation of sleep parameters.Results. It was found that individuals with high levels of sleep reactivity to stress were characterized by high levels of anxiety, restlessness, and neuroticism. According to results of Pittsburg questionnaire, a lower quality of sleep was revealed. These findings were correlated with objective indexes of sleep according to polysomnographic studies: less deep sleep and its lower efficiency due to sleep disturbances.Conclusions. Individuals with high sleep reactivity to stress are characterized by greater anxiety combined with subjective and objective sleep disturbance like insomnia type

ОЦЕНКА ПРИВЕРЖЕННОСТИ К ЗДОРОВОМУ ОБРАЗУ ЖИЗНИ СРЕДИ САМОСТОЯТЕЛЬНО ПРАКТИКУЮЩИХ ВРАЧЕЙ И ОБУЧАЮЩИХСЯ (СТУДЕНТОВ-МЕДИКОВ, ИНТЕРНОВ И КЛИНИЧЕСКИХ ОРДИНАТОРОВ)

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016. Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan). Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p<0.05, and comparable levels of salt overtaking (39 vs 34 %) and hypodynamia (35% in both groups). Only 10% of students and 7% of doctors smoked. The expected increase in the prevalence of biological risk factors in accordance with the age was significantly more common in doctors: hypercholesterolemia (63 vs 30 %), hyperglycemia (25 vs 14 %), hypertension (36 vs 5 %), obesity (according to WC – 45 vs 10 %, according to BMI – 19 vs 6 %), p<0.05. The profile of the most common risk factors did not differ among doctors and students: hypercholesterolemia and overweight in both groups took the leading positions. Also in accordance with the age, there were more often complaints of snoring-24% in doctors and 7% in students.Conclusion. The students had a less favorable profile of behavioral factors in diet compared to doctors, and despite of the expected age differences, a high prevalence of hypercholesterolemia and overweight was revealed. Obviously, it is necessary to strengthen educational work in this area at the stage of training of nurses and doctors to preserve the health of both medical personnel and their patients.Введение. Роль здорового образа жизни в рамках профилактики развития хронических неинфекционных заболеваний очень важна. Большое влияние на приверженность пациентов к здоровому образу жизни может иметь образ жизни медицинского персонала и, особенно, будущих врачей.Цель исследования – сравнить распространенность сердечно-сосудистых факторов риска среди врачей и студентов медицинских образовательных учреждений, прошедших скрининговое обследование во время Российского кардиологического конгресса в 2016 г. Материал и методы. Во время Национального конгресса кардиологов (г. Екатеринбург, 20–23 сентября 2016 г.) участники были скринированы на предмет наличия сердечно-сосудистых факторов риска. Участники заполнили опросник относительно социального статуса, характера питания и двигательной активности, статуса курения, частоты потребляемого алкоголя, приема терапии. Антропометрия выполнялась в соответствии со стандартными процедурами. Артериальное давление (АД) измерялось на правой руке в сидячем положении после 5-минутного отдыха автоматическим тонометром OMRON (Япония). Уровень холестерина и глюкозы крови измеряли экспресс-методом с помощью EasyTouch® GCHb (Тайвань).Результаты исследования. В рамках скрининга были обследованы 535 участников в возрасте 18–78 лет, большинство из которых (80 %) составили женщины. Студентов было 193, врачей – 342. По сравнению со студентами у врачей значимо чаще отмечалось достаточное потребление овощей, фруктов (50 vs 70 %) и рыбы (76 vs 88 %), р<0,05, и сопоставимый уровень злоупотребления солью (39 vs 34 %) и гиподинамии (35 % в обеих группах). Лишь 10 % студентов и 7 % врачей курили. Ожидаемым был рост распространенности биологических факторов риска с возрастом – у врачей значимо чаще встречалась гиперхолестеринемия (63 vs 30 %), гипергликемия (25 vs 14 %), артериальная гипертензия (36 vs 5 %), ожирение (согласно ОТ – 45 vs 10 %, согласно ИМТ – 19 vs 6 %), р<0,05. Профиль наиболее часто встречающихся факторов риска был сопоставим у врачей и студентов: лидирующие позиции заняли гиперхолестеринемия и избыточная масса тела в обеих группах. Также с возрастом чаще отмечались жалобы на храп – 24 % для врачей и 7 % для студентов.Заключение. У студентов был отмечен менее благоприятный профиль поведенческих факторов в области питания по сравнению с врачами, и, несмотря на ожидаемые возрастные различия, была отмечена достаточно высокая распространенность гиперхолестеринемии и избыточной массы тела. Очевидно, необходимо усилить просветительскую работу в данной сфере на этапе обучения среднего медперсонала и врачей для сохранения здоровья как медицинского персонала, так и их пациентов.

Main results of the Russian trial «ALTAIR»

The results of the multi-center, open, titrating trial of rilmenidine «ALTAIR» (ALbarel: effectiveness and Tolerability in ArterIal hypeRtension) are demonstrated. Aim. To assess antihypertensive effectiveness and safety of rilmenidine as monotherapy and in combination with amlodipine in out-patients with mild to moderate arterial hypertension (AH), to investigate its effects on quality of life and treatment compliance. Material and methods. The study involved 677 patients: 610 participants (90.4%) completely fulfilled the protocol, and another 67 (9.6%) dropped out. Therapy lasted for 16 weeks. Clinical visits were performed at Week 4, 8, 12 and 16 of the treatment. Results. Rilmenidine (1-2 mg/d) therapy in Stage I-II AH was associated with BP target level achievement in 46.6% of the cases, with good therapy tolerability. Adverse events were registered in 11.9% of the participants, but treatment discontinuation and study termination was necessary in 4.4% of the subjects only. Combination of rilmenidine and amlodipine (2.5-5 mg/d) resulted in responder percentage increase to 87.5%, with simultaneous increase in adverse event rates, though. Conclusion. ALTAIR trial results demonstrated high effectiveness and good tolerability of rilmenidine treatment, as monotherapy or in combination with amlodipine

OBSTRUCTIVE SLEEP APNEA SYNDROME IN CONGESTIVE HEART FAILURE: CARDIOLOGIST PERSPECTIVE

In the review, the data presented, on sleep disordered respiration in chronic heart failure patients with emphazis on sleep apnea syndrome (SAS). The aspects of prevalence are discussed, as of pathogenesis, diagnostics and specifics of SAS management in decreased or normal ejection fraction. The original results presented, on the disordered breathing assessment in patients with severe systolic dysfunction. The necessity underscored for personalized diagnostic and management approach to obstructive sleep apnea syndrome which is not just a risk factor for heart failure, but is a comorbidity at various stages of cardiovascular continuum

Cardiovascular effects of non-invasive ventilation in the treatment of breathing-related sleep disorders in bariatric patients

The article presents a non-systematic review of studies on breathing-related sleep disorders in patients with morbid obesity, and on the use of non-invasive ventilation in the pre-, peri-, and postoperative period of bariatric surgery, with an assessment of cardiovascular effects

ASSESSMENT OF HEALTHY LIFESTYLE COMPLIANCE AMONG PRIVATE-PRACTICE DOCTORS AND STUDENTS (MEDICAL STUDENTS, INTERNS AND CLINICAL RESIDENTS)

Introduction. The role of healthy lifestyles in the prevention of chronic non-communicable diseases is very important. Lifestyle of medical personnel, especially future doctors, may have great influence on healthy lifestyle compliance of patients. The objective of our study was to compare the prevalence of cardiovascular risk factors among doctors and students of medical educational institutions who underwent screening during The Russian Congress of Cardiology in 2016. Material and methods. During the Russian National Congress of Cardiology (Ekaterinburg, 20-23 September 2016), the participants were screened for the presence of cardiovascular risk factors. Participants filled out the questionnaire on the social status, nutrition, physical activity, smoking status, frequency of alcohol consumption, therapy. Anthropometry was performed in accordance with standard procedures. Blood pressure (BP) was measured on the right hand in a sitting position after a 5-minute rest with the automatic tonometer OMRON (Japan). The level of cholesterol and blood glucose was measured by express method using EasyTouch® GCHb (Taiwan). Results. The screening included 535 participants aged 18-78 years, the majority of whom (80 %) were women. There were 193 students, 342 doctors. Compared with students, doctors were significantly more likely to have sufficient intake of vegetables, fruits (50 vs 70 %) and fish (76 vs 88%), p<0.05, and comparable levels of salt overtaking (39 vs 34 %) and hypodynamia (35% in both groups). Only 10% of students and 7% of doctors smoked. The expected increase in the prevalence of biological risk factors in accordance with the age was significantly more common in doctors: hypercholesterolemia (63 vs 30 %), hyperglycemia (25 vs 14 %), hypertension (36 vs 5 %), obesity (according to WC – 45 vs 10 %, according to BMI – 19 vs 6 %), p<0.05. The profile of the most common risk factors did not differ among doctors and students: hypercholesterolemia and overweight in both groups took the leading positions. Also in accordance with the age, there were more often complaints of snoring-24% in doctors and 7% in students.Conclusion. The students had a less favorable profile of behavioral factors in diet compared to doctors, and despite of the expected age differences, a high prevalence of hypercholesterolemia and overweight was revealed. Obviously, it is necessary to strengthen educational work in this area at the stage of training of nurses and doctors to preserve the health of both medical personnel and their patients

THE RELATION OF SLEEP RESPIRATION DISORDERS AND CARDIOVASCULAR RISK

Aim. To assess the relation of obstructive sleep apnea syndrome (OSAS) by the data of Berlin questionnaire and risk of fatal cardiovascular events. Material and methods. Totally, 275 persons  studied (115 males, 160 females)  age  25-64 y.o., with unknown cardiovascular  complications, underwent structured  interview. The risk of sleep-disordered breathing was assessed by Berlin questionnaire, cardiovascular risk — by SCORE. Anthropometric  parameters  were  studied,   as  lipid profile,  fasting glucose, uric acid, creatinine, C-reactive protein, adiponectin, leptin. Results. The increased  OSAS risk according to Berlin questionnaire was found in 7,3% of the studies. Most (90,0%) common was concomitance of the  components   of OSAS such  as  snoring/stops of respiration  and cardiometabolic disorders. Males more frequently complained on snoring/ stops of breathing — 21,7% vs 6,3% (p=0,001), that determined  higher general risk of OSAS among them comparing to women — 11,3% vs 4,4% (p=0,03).  For males  (1,7%)  and  females  (3,1%)  the  complaints  on daytime sleepiness were less common. Among those 40 y.o. and older the increased  risk of OSAS was found in 9,8%, comparing to 1,2% younger than  40  y.o.  (p=0,01).  In higher  OSAS risk there  was  higher  total cholesterol  — 6,10±0,18  vs 5,53±0,09  mM/L (p=0,05) and low density lipoproteides — 4,17±0,19 vs 3,59±0,08 mM/L (p=0,02); they were more often overweight — body mass  index 31,73±1,19  vs 27,71±0,38  kg/m2 (p=0,001),   and   had   higher  systolic  pressure  —  134,89±4,96   vs 126,72±1,18  mmHg. (p=0,04) and diastolic pressure — 84,26±2,69  vs 78,55±0,80  mmHg (p=0,03).  Respondents with higher  risk of OSAS regardless the  gender,  did not differ by SCORE. While determine  the specific combinations of OSAS components, there was no independent significance of snoring/respiration  pauses  and daytime sleepiness  in the total cardiovascular risk by SCORE.Conclusion. In the Russian population, higher OSAS risk is associated with the signs of metabolic syndrome. Berlin questionnaire does not reveal the subgroups of those who have OSAS risk together with cardiovascular risk

PREVALENCE OF SLEEP DISORDERED BREATHING IN PATIENTS WITH NEWLY DIAGNOSED ACROMEGALY

Background: Obstructive sleep disordered breathing or obstructive sleep apnea (OSA) is the most common respiratory impairment in acromegaly. OSA is bound up with heightened cardiovascular mortality. Aim: Тo study frequency, features, and structure of sleep disordered breathing in patients with newly diagnosed acromegaly and to elucidate the factors influencing their development. Materials and methods: 38 patients (10 men, 28 women, median age 53 (28-76) years, median body mass index (BMI) 29 (19.9-44.3) kg/m²) with newly diagnosed acromegaly were recruited into the study. All subjects underwent full polysomnography (Embla N7000, Natus, USA) and Remlogica software (USA). Results: Sleep disordered breathing was found in 28 (73.7%) patients. OSA was revealed in all cases, in 11 (39.3%) subjects it was mixed. In 10 (35.7%) patients OSA was mild, in 8 (28.6%) moderate, and in 10 (35.7%) severe. BMI (р<0.01), disease duration (р=0.003), and insulin-like growth factor-1 (IGF-1) level (р=0.04) were different in patients without OSA and patients with moderate-to-severe OSA. No difference was found in sex (р=0.4), age (р=0.064), and growth hormone level (р=0.6). Frequency of arterial hypertension, diabetes mellitus, and other glucose metabolism impairments was the same in subjects without OSA and with severe-to-moderate OSA. Conclusion: All patients with newly diagnosed acromegaly should undergo polysomnography. BMI, disease duration, and IGF-1 level are significant risk factors for OSA development. Correlation OSA with arterial hypertension and glucose metabolism impairments needs to be further investigated

RELATIONSHIP OF SLEEP-DISORDERED BREATHING, EMOTIONAL COMPLAINTS AND ANTROPOMETRIC MEASUREMENTS (THE RESULTS OF SCREENING SURVEY AMONG SAINT-PETERSBURG CITIZENS)

Aim. To assess the prevalence of sleep-disordered breathing (SDB), their relation to emotional complaints, antropometric measures and life-style factors in representative cohort of a large city inhabitants (Saint-Petersburg).Material and methods. Using structured interview and antropometric methods we studied 358 citizens of Saint-Petersburg at the age of 21-68 y.o. The presence/absence of the following were evaluated: dyssomnias, SDB (snore, breathing pauses), emotional complaints, body mass index, life-style characteristics. 21,5% of respondents could not respond definitely about the sleep breathing quality, of those mostly women (25,9% vs 14,2%; p<0,05). Finally we analyzed 281 respondents 115 men and 166 women. Results. Regular snore do confirm 29,6% men and 22,9% women. Proportional increase of snoring with the age was found only in women (r=0,21; p<0,01). Apnea episodes are reported by 14,3% respondents. Clear differences by this parameter in men and women in different ages are not found. Not depending on gender and age the snore prevalence was related to obesity markers: body mass index (r=0,26; p<0,001) and waist circumference (r=0,24; p<0,001). There was no relationship of apnea prevalence and obesity markers. There was connection between snore prevalence with sleepiness level (r=0,21, p=0,001), emotional tension (r=0,24, p<0,001) and despondency (r=0,20, p<0,01), prevalence of bruxism (r=0,18, p<0,01) and awake with the feeling of suffocation/ heaviness in the chest (r=0,17, p<0,01). Apnea prevalence correlated with typicality of fatigue after night sleep (r=0,16, p<0,01), awake with the feeling of suffocation / heaviness in the chest (r=0,17, p<0,01), and with bruxism prevalence (r=0,16, p =0,01). There was no clear evidence of SDB with lifestyle connections.Conclusion. Every fourth adult of Saint-Petersburg shows the signs of SDB, which are linked with overall sleep quality decrease, dyssomnias and emotional complaints, and with obesity values