The Features of the Clinical Condition and Medical Rehabilitation of Patients with Ischemic Sergeum Disease, who Transferred Percutaneous Transthyminal Coronary Angiplasty with Apnea-Hypopnea Syndrome, Under Conditions of a Rehabilitation Center

The article presents the materials to identify the frequency of obstructive sleep apneahypopnea syndrome (OSA), the investigation of the features of the clinical picture of the cardiorespiratory system and the psychological state of patients with ischemic heart disease (CHD) after percutaneous transluminal coronary angioplasty, development and implementation of a program of medical rehabilitation of patients with non-invasive respiratory support constant positive pressure in the respiratory tract (CPAP therapy). General clinical, laboratory, instrumental and psychological research methods were used for the study.

It was revealed that in 35.7% of cases in operated patients with coronary heart disease sleep apnea-hypopnea syndrome can be found. The presence of OSA is associated with a more severe clinical picture of CHD, excessive daytime drowsiness, night snoring, headaches in the morning, a higher body mass index, poorly correctable hypertension, the presence of cardiac arrhythmias during sleep, correlating with the degree of severity of OSA. The inclusion in the comprehensive program of medical rehabilitation of patients with coronary heart disease with OSA after percutaneous transluminal coronary angioplasty of the method of non-invasive respiratory support – CPAP therapy provided an increase in the effectiveness of rehabilitation measures, improving the quality of life of this category of patients and reducing the risk of complications. It is shown that application of complex clinical-psychological research of patients with CHD and OSA after percutaneous transluminal coronary angioplasty improves the efficiency of rehabilitation (the restoration of the functional capacity of the organism of the operated patients), early medical rehabilitation and return to work that significantly adds to the scientific concept of medical rehabilitation for cardiosurgical patients with ischemic heart disease and OSA after percutaneous transluminal coronary angioplasty.

1. Aretinskij, V. B., Antjuf’ev, V. F., Shhegol’kov, A. M., Beljakin, S. A., Budko, A. A., Shakula, A. V., & Klimko, V. V. (2007). Vosstanovitel’noe lechenie bol’nyh ishemicheskoj bolezn’ju serdca posle hirurgicheskoj revaskuljarizacii miokarda. [Reconstructive treatment of patients with coronary heart disease after surgical myocardial revascularization]. Nauchnoe izdanie: Ekaterinburg-Moskva.

2. Babak, S. L., Golubev, L. A., & Gorbunova, M. V. (2010). Dyhatel’nye rasstrojstva i narushenija sna. Prakticheskoe rukovodstvo. [Respiratory and sleep disorders. A practical guide]. Atmosfera.

3. Bogoljubov, V. M. (2007). Medicinskaja reabilitacija. Rukovodstvo dlja vrachej. [Medical rehabilitation. Guide for doctors ], 3, 3-146.

4. Budko, A. A. (2002). Sistema medicinskoj reabilitacii voennosluzhashhih, perenesshih aortokoronarnoe shuntirovanie, v mnogoprofil’nom reabilitacionnom gospitale. [Medical rehabilitation system for military personnel who underwent coronary artery bypass grafting in a multidisciplinary rehabilitation hospital] [Doctoral dissertation]. Moscow, Russia.

5. Kalinina, S. V., Judin, B. E., Shhegol’kov, A. M., & Klimko, V. V. (2013). Kompleksnaja programma medicinskoj reabilitacii bol’nyh ishemicheskoj bolezn’ju serdca s sindromom obstruktivnogo apnoje-gipopnoje sna posle koronarnoj angioplastiki. [A comprehensive program of medical rehabilitation of patients with coronary heart disease with obstructive sleep apnea-hypopnea syndrome after coronary angioplasty]. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova [Bulletin of the Pirogov National Medical and Surgical Center], 4(8), 124-130.

6. Klimko, V. V., Starikov, S. M., & Kalinina, S. V. (2011). Vyjavlenie i korrekcija sindroma obstruktivnogo apnoje u bol’nyh IBS posle chreskozhnoj transljuminal’noj angioplastiki. [Identification and correction of obstructive apnea syndrome in patients with coronary heart disease after percutaneous transluminal angioplasty.] Voenno-medicinskij zhurnal [Military Medical Journal], 12, 39-40.

7. Klimko, V. V. (2009). Optimizacija jetapnoj medicinskoj reabilitacii bol’nyh ishemicheskoj bolezn’ju serdca, perenesshih koronarnoe shuntirovanie. [Optimization of staged medical rehabilitation of patients with coronary heart disease after coronary artery bypass grafting][Doctoral dissertatuion]. Moscow, Russia.

8. Kljachkin, L. M., & Shhegol’kov, A. M. (2000). Medicinskaja reabilitacija bol’nyh s zabolevanijami vnutrennih organov. [Medical rehabilitation of patients with diseases of the internal organs.] Medicina.

9. Mandrykin, S. Ju. (2005). Medicinskaja reabilitacija bol’nyh ishemicheskoj bolezn’ju serdca, perenesshih chreskozhnuju transljuminal’nuju koronarnuju angioplastiku. [Medical rehabilitation of patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty] [Doctoral dissertation]. Moscow, Russia.

10. Mandrykin, S. Ju., Shhegol’kov, A. M., & Anuchkin, A. A. (2004). Sovremennoe sostojanie problemy jendovaskuljarnogo lechenija i reabilitacii bol’nyh ishemicheskoj bolezn’ju serdca. [The current state of the problem of endovascular treatment and rehabilitation of patients with coronary heart disease], Fizioterapija, bal’neologija, reabilitacija. [Physiotherapy, balneology, rehabilitation], 3, 3842.

11. Pal’man, A. D. (2007) Sindrom obstruktivnogo apnoje vo sne v klinike vnutrennih boleznej, [Syndrome of obstructive sleep apnea in the clinic of internal diseases]. Moskva.

12. Ponomarenko, G. N. (2016). Fizicheskaja i reabilitacionnaja medicina: nacional’noe rukovodstvo [Physical and rehabilitation medicine: national leadership]. GJeOTAR - Media.

13. Sidel’nikov, A. V. (2002). Sravnitel’naja ocenka otdalennyh rezul’tatov stentirovanija koronarnyh arterij provolochnym stentom Crossflex i transljuminal’noj ballonnoj angioplastiki u bol’nyh IBS. [Comparative evaluation of long-term results of coronary artery stenting with Crossflex wire stent and transluminal balloon angioplasty in patients with coronary artery disease] [Candidate dissertation, Scientific and Practical Center for Interventional Cardioangiology]. Moscow, Russia.

14. Chazova, I. E., & Litvin, A. Ju. (2006). Sindrom obstruktivnogo apnoje vo vremja sna i svjazannye s nim serdechno-sosudistye oslozhnenija, [Obstructive sleep apnea syndrome and related cardiovascular complications], Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology], 1, 75-86.

15. Chuchalin, A. G. (2009). Pul’monologija: Nacional’noe rukovodstvo. [Pulmonology: National Leadership] GJeOTAR- Media.

16. Shhegol’kov, A. M., Kljachkin, L. M., Budko, A. A., & Klimko, V. V. (1999). Optimization of the construction of a rehabilitation program for patients with coronary heart disease who underwent CABG surgery at the hospital stage of rehabilitation. In Sovremennye podhody k professional’noj i medicinskoj reabilitacii spasatelej [Modern approaches to professional and medical rehabilitation of rescuers] (pp. 140-141).

17. Shhegol’kov, A. M., & Mandrykin, S. Ju. (2006). Medical rehabilitation of patients with coronary heart disease who underwent percutaneous transluminal coronary angioplasty. Fizioterapija, bal’neologija i reabilitacija [Physiotherapy, balneology and rehabilitation], 6, 6-10.

18. Judin, V. E., Shhegol’kov, A. M., Klimko, V. V., Budko, A. A., Starikov, S. M., & Kalinina, S. V. (2011). Improving the efficiency of medical rehabilitation of patients with coronary heart disease with obstructive sleep apnea-hypopnea syndrome after percutaneous transluminal angioplasty. Vestnik vosstanovitel’noj mediciny, [Bulletin of regenerative medicine], 5(45), 25 -27.

19. Milleron, O., Pilliere, R., Foucher, A., de Roquefeuil, F., Aegerter, P., Jondeau, G., Raffestin, B. G., & Dubourg, O. (2004). Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. European Heart Journal, 25,9, 728-734. https://doi.org/10.1016Zj.ehj.2004.02.008

20. Peker, Y., Hedner, J., Norum, J., Kraiczi, H., & Carlson, J. (2002). Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea:a 7-year follow-up. American Journal of Respiratory and Critical Care Medicine, 166, 159-65. https://doi.org/10.1164/rccm.2105124

21. Shamsuzzaman, A. S., Gersh, B. J., & Somers, V. K. (2003). Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA, 290(14),1906-1914. https://doi.org/10.1001/jama.290.14.1906