Disorders in the blood coagulation system play an important role in the development of cardiovascular pathology in diabetes. Factors that cause them are hyperglycemia, insulin deficiency, insulin resistance, dyslipidemia, oxidative stress. The most significant changes are observed in the vascular-platelet link of hemostasis. Diabetes is characterized by morphological and functional changes in the endothelium of blood vessels. The activity of platelets increases, which is manifested by their high level of spontaneous aggregation and increased sensitivity to the action of activating factors. The role in the disturbance of hemostasis is played by increasing the activity of the von Willebrand factor, reflecting damage to endothelial cells. Diabetes is characterized by an increase in the activity of plasma clotting factors (I, II, III, VII, VIII, IX, XI, XII and XIII), activation of the callicrein-kinin system. In some cases, this correlates with the development of complications of diabetes. Characteristic disorders in the coagulation inhibition system are a decrease in the activity of antithrombin III, reduced formation of thrombin-antithrombin complexes, reduction of thrombomodulin and protein C. In diabetes, there is a decrease in fibrinolysis, due to a decrease in the expression of tissue activator plasminogen and an increase in the level of the inhibitor of the activator plasminogen. The possibilities of drug correction of hypercoagulation factors in diabetes are to achieve glycemic control with sugar-reducing drugs and elimination of dyslipidemia through hypolipidemic therapy. The most well-studied sugar-lowering drug that improves the state of the blood clotting system is metformin. The system of hemostasis in diabetic patients is positively affected by statins both due to the direct hypolipidemic effect, and by improving endothelial function and increasing fibrinolysis.

No abstract

Aim. To evaluate the change in the parameters of systolic and diastolic myocardial functions in patients with severe obstructive sleep apnea (OSA) syndrome before and after CPAP therapy. Materials and methods. Forty eight patients with severe OSA aged 4574 years were examined. All patients underwent questionnaires, echocardiography with tissue Dopplerography, speckle-tracking echocardiography. At the end of the three-month course of CPAP therapy, the patients were re-examined, followed by a comparative analysis of the data obtained. Results. In patients with severe OSA after CPAP therapy, the ejection fraction of the left ventricle and the amplitude of systolic displacement of the fibrous ring of the tricuspid valve significantly increased, which indicated an increase in the relative capacity of the ventricular myocardium. The performed CPAP therapy had a positive effect on the diastolic function of the myocardium of both ventricles, which was manifested in an increase in the ratio of peak rates of early and late transmitral and transtricuspidal diastolic flows. The rate of transtricuspidal regurgitation and systolic pressure in the pulmonary artery decreased in dynamics. Conclusion. The use of CPAP therapy improves systolic and diastolic heart function, leads to a decrease in systolic pressure in the pulmonary artery in patients with severe OSA. The results obtained substantiate the importance of early initiation of CPAP therapy in the complex treatment of patients with OSA.

Background. Obstructive sleep apnea (OSA) is frequently associated with hypertension (HTN), and about 50 % hypertensive patients have concomitant OSA. Episodes of transient upper airway obstruction affect the daily blood pressure profile, leading to nocturnal HTN. Although the general relationship between OSA and the daily blood pressure profile is known, the association between the frequency of various daily blood pressure profiles and OSA severity as well as the age-specific differences remain unknown. The aim of the study was to determine the daily blood pressure profiles in patients with HTN and OSA, depending on the OSA severity and age. Design and methods. The study included 236 HTN patients underwent treatment in the period from 2008 to 2021 years and were diagnosed with OSA by cardiorespiratory monitoring: 84 patients had mild OSA (apnea/hypopnea index (AHI) < 15 episodes/h), 46 patients — moderate OSA (15 ≤ AHI < 30 episodes/h), and 106 patients — severe OSA (AHI ≥ 30 episodes/h). The control group included 140 HTN patients without OSA. Both groups were divided into 3 age subgroups: younger than 45 years, 45–59 years and ≥ 60 years. At baseline, all patients underwent cardiorespiratory monitoring (“Kardiotekhnika‑07–3/12P”, Inkart, St Petersburg, Russia) and 24-hour blood pressure (BP) monitoring (BPLab, Nizhny Novgorod, Russia). Results. We found an association between the distribution of daily BP profiles and age, which differs from that in HTN patients without OSA. Non-dipper and night-peaker BP profiles are predominant in young and middle age. Among OSA patients, the severity of OSA was associated with the BP profiles only in the young and middleage groups. Unfavorable BP profiles (non-dipper and night-peaker) were more common in patients with severe OSA, which was not observed in elderly subgroup. In the elderly, compared to younger patients, the overdipper profile was the most common and its frequency was not associated with OSA severity. Conclusions. The study shows the relationship between the age of patients with HTN and OSA, the OSA severity and the distribution of daily BP profiles.