Factors of vascular endothelial dysfunction and thrombogenic risk in patients with chronic obstructive pulmonary disease in combination with obstructive sleep apnea after an exacerbation

Abstract

Obstructive sleep apnea (OSA) is a common disease. The incidence is higher in patients with chronic obstructive pulmonary disease with moderate to severe bronchial obstruction or hypoxemia. OSA is associated with increased risks of fatal outcomes of acute cardiovascular diseases in such patients. Objective. To assess the effect of long-term non-invasive ventilation of the lungs in the spontaneous breathing mode with positive airway pressure (CPAP) on the indicators of systemic inflammation, insulin resistance, and thrombogenic risk together with clinical outcomes during the rehabilitation period after an exacerbation in patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea who do not need long-term oxygen therapy. Methods . The effects of long-term CPAP therapy as a part of complex treatment were analyzed in an openlabel, prospective, comparative six-week study that enrolled 65 patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea. The main group included 26 people who received CPAP therapy as a part of complex treatment. The comparison group included 39 people who did not use non-invasive ventilation of the lungs. The patients’ age was 55.5 ± 2.1 years in the main group and 57.1 ± 1.5 years in the comparison group ( p > 0.1). Men prevailed in both groups – 92.3% in the main group and 100.0% in the comparison group ( p > 0.1). Results . The clinical efficacy of CPAP therapy was confirmed by an improvement in the quality of life of patients on the SF-36 questionnaire, a decrease in the degree of daytime sleepiness on the Epworth scale (Johns, 1991). CPAP-therapy was associated with a drop in the serum levels of tumor necrosis factor α and the blood level of endothelin 1, a more pronounced decrease in the levels of C-reactive protein, interleukin 8, C-peptide, vascular endothelial growth factor, homocysteine versus the comparison group. Conclusion . The use of CPAP-therapy in patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea who do not need long-term oxygen therapy during the rehabilitation period after an exacerbation is associated with a decrease in systemic inflammation, vascular endothelial dysfunction, and hyperhomocysteinemia.