Zuzana Sopková, Miroslav Brúsik, Zuzana Dorková, Radovan Tiško, Ružena Tkáčová
Obstructive sleep apnoea (OSA) is characterized by repeated episodes of total or partial upper airway occlusion during sleep resulting in apnoeic or hypopnoeic episodes. Arterial hypertension is the most prevalent cardiovascular comorbidity in OSA patients. Repetitive cycles of hypoxaemia and reoxygenation are accompanied by increased sympathetic activity, oxidative stress, activation of the renin-angiotensin-aldosterone system and endothelial dysfunction that contribute to acute rise in blood pressure (BP) during sleep as well as to the persistence of elevated BP during wakefulness. Patients with resistant hypertension and non-dippers have increased prevalence of OSA. Unrecognized OSA in the presence of poorly controlled hypertension increases the cardiovascular risk substantially. Therefore, in the presence of symptoms suggestive of OSA such as history of snoring, apnoeic pauses and excessive daytime sleepiness, examination in the sleep laboratory is strongly recommended. In the cohort of 536 patients examined in the Laboratory for Sleep Disordered Breathing, Department of Respiratory Medicine and Tuberculosis, Medical Faculty, PJ Safarik University in Kosice we diagnosed severe OSA in 236 cases. OSA was associated with increased prevalence of cardiovascular diseases, dyslipidaemia and diabetes type 2. Among patients who reported the use of more than 2 antihypertensive drugs the prevalence of OSA was 87 % (58 % for severe OSA). Long-time non-invasive ventilation represents golden standard for treatment of moderate and severe OSA. However, non-invasive ventilation per se is frequently not sufficient to achieve BP control, and therefore adequate antihypertensive medication is required. Recent data suggest synergic effects of non-invasive ventilation and aldosterone antagonists on BP in patients with OSA and concurrent arterial hypertension.