pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2016-26-3-379-384pulmo-731Research ArticleЗАМЕТКИ ИЗ ПРАКТИКИPRACTICAL NOTESПодбор эффективной терапии при синдроме обструктивного апноэ / гипопноэ сна, ассоциированной с высокогорной легочной гипертонией в условиях высокогорьяDevelopment of the optimal therapy for obstructive sleep apnea syndrome associated with pulmonary hypertension patients living at high altitudeМырзаахматоваА. К.MyrzaakhmatovaA. K.

научный сотрудник отделения пульмонологии и аллергологии Национального центра кардиологии и терапии имени академика М.Миррахимова при Минздраве Республики Кыргызстан; тел.: (996 312 55) 5738976

Researcher at pulmonology and Aller gology Department, Academician M.Mirrakhimov National Center of Cardiology and Therapy; tel.: (+996) 312622763

mak7171@mail.ruНациональный центр кардиологии и терапии имени академика М.Миррахимова при Минздраве Республики Кыргызстан: 720040, Кыргызстан, Бишкек, ул. Тоголок Молдо, 3РоссияAcademician M.Mirrakhimov National Center of Cardiology and Therapy: 3, Togolok Moldo str., Bishkek, 720040, KyrgyzstanRussian Federation201627072016263379384Copyright © Мырзаахматова А.К., 20162016Мырзаахматова А.К.Myrzaakhmatova A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/731

Представлен клинический случай подбора терапии для коренного жителя высокогорья с синдромом обструктивного апноэ / гипопноэсна и высокогорной легочной гипертонией. Показано, что наиболее эффективным лечением в условиях высокогорья является метод комбинированной терапии методом создания постоянного положительного давления в дыхательных путях (СРАР) + ацетазоломид.

The aim of this study was to evaluate prevalence, clinical and functional markers of obstructive sleep apnoea syndrome (OSAS) and to develop the optimal therapy for this disease in patents living at high altitude.

Methods

Methods. The study protocol included physical examination, special respiratory questionnaires, 6"min walk test, spirometry, echocardiography, capnography and polysomnography. The trial treatment included CPAP therapy, acetazolamide or combination of both.

Results

Results. A male patient, 62 years of age, with OSAS associated with pulmonary artery hypertension (PAH) was reported in the article according to the study protocol. The combined therapy with CPAP + acetazolamide was the most effective and resulted in improvement in the sleep quality, oxygen saturation, dyspnea, РtcСО2, hypertension, and the heart beat rate.

Conclusion

Conclusion. The combined therapy with CPAP + acetazolamide could be considered as the optimal treatment for patients with OSAS and PAH. OSAS in patients living at high altitude requires further investigations.

синдром обструктивного апноэ / гипопноэ сналегочная гипертониявысокогорьеСРАР"терапияацетазоломидobstructive sleep apnea syndromepulmonary hypertensionhigh altitudeCPAP therapyacetazolamideReferencesNormand H., Vargas E., Bordachar J. et al. Sleep apneas in high altitude residents (3,800 m). Int. J. Sports. Med. 1992; (13, Suppl. 1): 40–42.Normand H., Vargas E., Bordachar J. et al. Sleep apneas in high altitude residents (3,800 m). Int. J. Sports. Med. 1992; (13, Suppl. 1): 40–42.Yang S.Y., Luo X.H., Feng E.Z. et al. Analysis of prognostic risk factors in the patients with acute exacerbation of chronic corpulmonale and obstructive sleep apnea"hypopnea syndrome in high altitude area. Zhongguo Wei Zhong Bing JiJiu Yi Xue. 2010; 22 (5): 271–274.Yang S.Y., Luo X.H., Feng E.Z. et al. Analysis of prognostic risk factors in the patients with acute exacerbation of chronic corpulmonale and obstructive sleep apnea"hypopnea syndrome in high altitude area. Zhongguo Wei Zhong Bing JiJiu Yi Xue. 2010; 22 (5): 271–274.Kondo T., Ishii H., Tazaki G., Toda M. Exacerbation of obstructive sleep apnea syndrome at altitude 3,850 m. Nichon Kokyuki Gakkai Zasshi. 2008; 46 (12): 1034–1038.Kondo T., Ishii H., Tazaki G., Toda M. Exacerbation of obstructive sleep apnea syndrome at altitude 3,850 m.Nichon Kokyuki Gakkai Zasshi. 2008; 46 (12): 1034–1038.Nussbaumer"Ochsner Y., Latshang T.D., Ulrich S.et al. Patients with obstructive sleep apnea syndrome benefit from acetazolamide during an altitude sojourn: a randomized, placebo"controlled, double"blind trial. Chest. 2012; 141 (1): 131–138.Nussbaumer"Ochsner Y., Latshang T.D., Ulrich S.et al. Patients with obstructive sleep apnea syndrome benefit from acetazolamide during an altitude sojourn: a randomized, placebo"controlled, double"blind trial. Chest. 2012; 141 (1): 131–138.Latshang T.D., Bloch K.E. How to treat patients with obstructive sleep apnea syndrome during an altitude sojourn. High Alt. Med. Biol. 2011; 12 (4): 303–307.Latshang T.D., Bloch K.E. How to treat patients with obstructive sleep apnea syndrome during an altitude sojourn. High Alt. Med. Biol. 2011; 12 (4): 303–307.Hultgren H.N. High Altitude Medicine. Stanford: Hultgren Publications; 1997: 12.Hultgren H.N. High Altitude Medicine. Stanford: Hultgren Publications; 1997: 12.Миррахимов М.М., Мейманалиев Т.С. Высокогорная кардиология. Фрунзе: «Кыргызстан»; 1984.Mirrakhimov M.M., Meymanaliev T.S. High"altitude cardiology. Frunze: «Kyrgyzstan»; 1984 (in Russian).Миррахимов М.М, Сооронбаев Т.М. Болезни легких и высокогорье. В кн.: Чучалин А.Г., ред. Респираторная медицина: руководство. М.: ГЭОТАР"Медиа; 2007. Т. 2: 382–399.Mirrakhimov M.M, Sooronbaev T.M. Pulmonary disease and high"altitude. In: Chuchalin A.G., ed. Respiratory Medicine. Moscow: GEOTAR"Media; 2007. V. 2: 382–399 (in Russian).Kessler R., Chaouat A., Weitzenblum E. et al. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur. Respir. J. 1996; 9 (4): 787–794.Kessler R., Chaouat A., Weitzenblum E. et al. Pulmonary hypertension in the obstructive sleep apnoea syndrome: prevalence, causes and therapeutic consequences. Eur. Respir. J. 1996; 9 (4): 787–794.Bady E., Achkar A., Pascal S. et al. Pulmonary arterial hypertension in patients with sleep apnea syndrome. Thorax. 2000; 55 (11): 934–939.Bady E., Achkar A., Pascal S. et al. Pulmonary arterial hypertension in patients with sleep apnea syndrome. Thorax. 2000; 55 (11): 934–939.Weaver T.E., Calik M.W., Farabi S.S. et al. Innovative treatments for adults with obstructive sleep apnea. Nat. Sci. Sleep. 2014; 6: 137–147.Weaver T.E., Calik M.W., Farabi S.S. et al. Innovative treatments for adults with obstructive sleep apnea. Nat. Sci. Sleep. 2014; 6: 137–147.Fischer R., Lang S.M., Leitl M. et al. Theophylline and acetazolamide reduce sleep"disordered breathing at high altitude. Eur. Respir. J. 2004; 23 (1): 47–52.Fischer R., Lang S.M., Leitl M. et al. Theophylline and acetazolamide reduce sleep"disordered breathing at high altitude. Eur. Respir. J. 2004; 23 (1): 47–52.Latshang T.D., Nussbaumer"Ochsner Y., Henn R.M. et al. Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude: a randomized controlled trial. JAMA. 2012; 308 (22): 2390–2398.Latshang T.D., Nussbaumer"Ochsner Y., Henn R.M. et al. Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude: a randomized controlled trial. JAMA. 2012; 308 (22): 2390–2398.Ng A., Gotsopoulos H., Darendeliler A.M., Cistulli P.A. Oral appliance therapy for obstructive sleep apnea. Treat. Respir. Med. 2005; 4 (6): 409–422.Ng A., Gotsopoulos H., Darendeliler A.M., Cistulli P.A. Oral appliance therapy for obstructive sleep apnea. Treat.Respir. Med. 2005; 4 (6): 409–422.Güvenç T.S., Hüseyinoglu N., Özben S. et al. Right ventricular geometry and mechanics in patients with obstructive sleep apnea living at high altitude. Sleep Breath. 2015; 19: 3539–3540.Güvenç T.S., Hüseyinoglu N., Özben S. et al. Right ventricular geometry and mechanics in patients with obstructive sleep apnea living at high altitude. Sleep Breath. 2015; 19: 3539–3540.Kushida C.A., Littner M.R. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005; 28 (4): 499–518.Kushida C.A., Littner M.R. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005; 28 (4): 499–518.Ward M.P., Milledge J.S., West J. High Altitude Medicine and Physiology. New York: Oxford University Press Inc.; 2000.Ward M.P., Milledge J.S., West J. High Altitude Medicine and Physiology. New York: Oxford University Press Inc.;2000.Patz D., Spoon M.,Corbin R. et al. The effect of altitude descent on obstructive sleep apnea. Chest. 2006; 130 (6):1744–1750.Patz D., Spoon M.,Corbin R. et al. The effect of altitude descent on obstructive sleep apnea. Chest. 2006; 130 (6):1744–1750.Galie N., Hoeper M.M., Humbert M. et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur. Heart J. 2009; 30: 2493–2537.Galie N., Hoeper M.M., Humbert M. et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplanta" tion (ISHLT). Eur. Heart J. 2009; 30: 2493–2537.Galie N., Hoeper M.M., Humbert M. et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur. Respir. J. 2009; 34: 1219–1263.Galie N., Hoeper M.M., Humbert M. et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur. Respir. J. 2009; 34: 1219–1263.

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