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Obstructive sleep apnea (OSA) is a common, heterogeneous chronic disease with sleep fragmentation, metabolic and cardiovascular disorders. Continuous Positive Air Pressure (CPAP) therapy is the primary treatment for patients with OSA. However, the effects of long-term CPAP therapy with night sessions > 6 hours remain poorly understood. The aim of the study was to study the effects of different durations of night sessions of CPAP therapy on the “metabolic profile” of patients with severe OSA. Materials and methods. In a retrospective case-control study comparing two CPAP-therapy regimens by matching pairs from among patients with verified severe OSA (apnea-hypopnea index> 30/h), arterial hypertension, obesity of I-II degrees according to the WHO classification (1997), signed informed consent, 2 groups of 18 people each were formed, comparable in age, anthropometric and somnographic indicators, using CPAP therapy 4-6 hours / night and more than 6 hours / night, respectively. Patients received CPAP therapy for a year, visits were carried out at 3, 6 and 12 months. The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. The optimal therapeutic level of CPAP therapy was titrated at home using devices for automatic selection of therapeutic pressure (PR System One REMstar Auto CPAP Machine with A-Flex (Philips Respironics, USA)) within 7 days after the diagnostic study. To assess the compliance of OSA patients at 3-6-12 months of CPAP-therapy, we used the original compliance analysis program Encore Pro v.2.14 (Philips Respironics, USA). Results. With the initial comparability of the groups, by the 3rd month of therapy, patients with CPAP > 6 h/night showed a statistically significant advantage over the patients with 4-6 h CPAP-therapy in ESS, neck circumference and testosterone. By the 6th month, statistically significant differences of BMI, VAI, leptin, oral glucose tolerance test, fasting insulin, HOMA-IR, lipid metabolism (HDL, LDL, triglycerides, Apo-B) appeared. By the 12th month of therapy, the CPAP group > 6 h/night had a statistically significant advantage in waist circumference, fasting blood glucose and uric acid. Differences between groups at control points persisted throughout the observation period. Conclusions. Long-term home-based CPAP therapy with sessions > 6 h/night has an advantage over therapy with sessions 4-6 h/night in achieving a rapid and pronounced improvement in metabolic profile and hormonal levels in patients with severe OSA.

The concept of tobacco harm reduction (THR) is a speculative and controversial topic in the context of the international battle against the use of all types of tobacco. This concept involves providing tobacco users who are unable or unwilling to quit smoking or using other types of tobacco (snuff, chewing), with modified risk tobacco product (MRTP) for continued use. Skepticism about THR is huge and is associated with the negative experience of tobacco companies to produce cigarettes with a low content of tobacco tar/nicotine, which should have had significantly lower health risks than conventional cigarettes. Paradoxically, such an experience served as a springboard to an increase in the number of tobacco products that potentially have the properties of MRTP. Moreover, some members of the anti-smoking coalition, including WHO, consider the transition of tobacco smokers to MRTP as a strategy with great potential. However, the European Group of Experts believes that the MRTP strategy does not work and will lead to another generation of young people getting used to tobacco. In this article, we have critically analyzed the history of the past and present of tobacco products, myths and contradictions around them. We have tried to evaluate the modern concept of S THR as objectively as possible, which has a high potential for a real reduction in the number of deaths associated with smoking.

In the presented clinical review, we evaluated the possibilities of drug and non-drug strategies for eliminating and preventing pathophysiological changes in the respiratory system of post-COVID-19 patients. We offer up-to-date rehabilitation algorithms based on the assessment of the severity of clinical manifestations of COVID-19, the possibilities of rehabilitation techniques and the patient’s personal compliance with their implementation.

Obstructive sleep apnea (OSA) is diagnosed in 25% of adults and associated with high fatal risks of cardiovascular complications. Left ventricular hypertrophy (LVH) is recognized as one of the markers of such risks. In this study, we attempted to create a mathematical model for predicting LVH among OAS patients with various levels of disease severity.Materials and methods. In a prospective cohort study, we included 368 patients (358 male; age 46.0 [42.0; 49.0] yr.) with diagnosed OSA, arterial hypertension, grade I-II obesity (WHO classification 1997). The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. Verification of LVH was performed in one- and two-dimensional modes in standard echocardiographic positions using Xario-200 ultrasound scanner (Toshiba, Japan) with 3.5 MHz transducer. Hemodynamic parameters of left ventricular (LV) systolic function (EF %, ESV, EDV) were determined by quantitative assessment of two-dimensional echocardiograms using the modified Simpson method. Evaluation of the systolic function of the right ventricle (RV) was performed in the «M»-mode by measuring the systolic excursion of the fibrous ring of the tricuspid valve (TAPSE).Results. ESS and TSat90% (AUC = 0.975; SD = 0.00741; CI 95% [0.953; 0.988]) should be considered the best predictors for predicting LVH in various degrees of OSA severity, allowing us to offer a predictive model with a sensitivity of 93.7% and specificity of 93.8%, after conducting a questionnaire screening and computer somnographic study.Conclusions. Our proposed model of clinical prediction of LVH among patients with various degrees of OAS is based on a carefully planned analysis of questionnaire and instrumental data, and is well applicable in real diagnostic procedures by a wide range of therapeutic practitioners.

Background: Numerous studies on the pathophysiological mechanisms of obstructive sleep apnea discover the relationship between obstructive sleep apnea and cardiovascular diseases, its contribution to the development of resistant hypertension and endothelial remodeling. Continuous Positive Airway Pressure (CPAP) is the only reasonable pathogenetic therapy in these patients. This treatment regimen implies the creation of a “pneumatic stent” with a given level of positive pressure on the inhalation and exhalation of the patient, allowing to stabilize the lumen of the upper respiratory tract and prevent the pharyngeal collapse. However, the effects and the required duration of CPAP of night sessions to achieve the target values of blood pressure and restore arterial stiffness in patients with severe obstructive sleep apnea with resistant hypertension remain poorly understood. Objective: to study the dynamics of blood pressure, arterial stiffness and endothelial dysfunction in patients with severe obstructive sleep apnea with resistant hypertension, depending on the duration of auto-adjusting CPAP (A-Flex therapy). Methods: the prospective single-center study enrolled 168 patients with obstructive sleep apnea with resistant hypertension (139 males, 46,6 ± 9,0 y. o.) with apnea-hypopnea index >30 events /hour. The night polygraphy study was performed to calculate AHI, oxygen desaturation index, mean nocturnal saturation (SpO2 ) according to the requirements of American Academy of Sleep Medicine. Endothelial function of blood vessels was assessed manually to peripheral arterial tone. The reactive hyperemia index and augmentation index was calculated. Blood pressure was monitored by office measurement, daily monitoring of blood pressure, and by individual patient diaries. Optimal level of CPAP-treatment was adjusted at home. Apnea-hypopnea index, the level of air leakage, average pressure and compliance to CPAP-therapy were established in accordance with international requirements. Results: In the group of patients, treated with night sessions of A-Flex > 6 h/night, significant dynamics was observed by the 6th month of treatment. That is, a decrease in RHI by -1.33 (95% CI from -2.25 to -0.41; P = 0.002), a decrease in AI by -12.4% (95% CI from -18.42 to -6.38; P = 0.001), a decrease in mean SBP (24 h) by -33.6 mm Hg (95% CI from -44.1 to -23.2; P = 0.002) and decrease in mean DBP (24 h) by -20.2 mm Hg (95% CI from -29.4 to -11.1; P = 0.001), with a decrease in rate of morning rise of SPB by -22.4 mm Hg/h (95% CI from -24.7 to -20.1; P = 0.002) and a decrease in rate of morning rise of DPB by -17.4 mm Hg/h (95% CI from -19.5 to -15.3; P = 0.003). The best target values were achieved by the 12th month of treatment: a decrease in RHI by -2.11 (95% CI from -2.57 to -1.65; P = 0.001), a decrease in AI by -28.5% (95% CI from -37.06 to -19.94; P = 0.002), a decrease in mean SBP (24 h) by -39.7 mm Hg (95% CI from -48.9 to -30.5; P = 0.001) and decrease in mean DBP (24 h) by -26.8 mm Hg (95% CI from -36.1 to -17.5; P = 0.001), with a decrease in rate of morning rise of SPB by -22.5 mm Hg/h (95% CI from -23.6 to -21.4; P = 0.001) and a decrease in rate of morning rise of DPB by -19.4 mm Hg/h (95% CI from -20.7 to -18.1; P = 0.002). Conclusions: in patients with severe obstructive sleep apnea and resistant hypertension only CPAP-therapy in the A-Flex mode > 6 h/night allows to achieve target blood pressure, restores endothelial function and arterial stiffness, therefore reducing the risks of cardiovascular complications.

Background. The relationship between obstructive sleep apnea (OSA) and hypertension (AH) is well known. In numerous studies it was found that obstructive sleep apnea was an independent predictor of the development of resistant AH (RAH), and the severity of apnea was directly correlated with the severity of RAH with the exception of the such confounders as age, obesity, sex.The purpose of this publication is to present a new strategy and modern approaches of drug and non-drug therapy of resistant hypertension in patients with OAS with the possibility of their implementation in real clinical practice.Conclusion. Currently, for a practitioner, the therapy of the patient with OSA and RAH is a serious clinical problem. A new rational therapeutic strategy for the treatment of such patients includes a combination of three-component drug therapy and non-drug continuous positive air pressure therapy (CPAP therapy). A reasonable duration of CPAP therapy should exceed 12 weeks. The proposed strategy for the treatment of patients with OAS+RAH has the highest efficiency of achieving blood pressure levels and significantly reduces the risks of fatal cardiovascular events.

Background: obstructive sleep apnea (OSA) is associated with high prevalence of arterial hypertension (AH), obesity, violation of carbohydrate metabolism and dyslipidemia. However, the effects of CPAP therapy to improve epicardial fat thickness of the OSA patient with AH the are poorly understood and poorly studied.Study objective: the aim of the study was to investigate 12-month effects of CPAP therapy with auto-adaptation to inhalation and exhalation of the OSA patient with AH and metabolic disorders (A-Flex therapy) on epicardial fat thickness (EFT).Methods: to the prospective single-center study were included 310 patients with OSA and AH (273 male, 45,3 ± 10,4 yr.) with apnea-hypopnea index (AHI) >5 events /hour. The night polygraphy study (PG) was performed to calculate AHI, oxygen desaturation index (ODI), mean nocturnal saturation (SpO 2 ) by the rules of American Academy of Sleep Medicine (AASM). The calculation of the epicardial fat thickness (EFT), the size and volume of the heart cavities, left ventricular mass index (LVMI) were performed by two-dimensional echocardiography. Endothelial functionof blood vessels determined by finger test was measured according to peripheral arterial tone (PAT). The reactive hyperemia index (RHI) and augmentation index (AI) was calculated. Optimal level of A-Flex therapy was adjusted at home. AHI, the level of air leakage, average pressure and compliance to CPAP treatment were established in accordance with international requirements.Results: after 3 months of A-Flex therapy we found a significant decrease of HOMA-IR -1,09 (95% Cl from -1,74 to -0,96; P=0,021), decrease AI -10.8% (95% Cl from -13,70 to -4.6; P=0,001), decrease EFT -1,26 mm (95% Cl from -2,2 to -0,95; P=0,001) in mild OSA patients. After 6 months of A-Flex therapy we found a significant decrease of HOMAIR -2,81 (95% Cl from -3,74 to -1,46; P=0,001), decrease AI -15.6 % (95% Cl from -17,23 to -11,75; P=0,001), decrease EFT -2,15mm (95% Cl from -3,2 to -1,5; P=0,001) in moderate OSA patients. After 12 months of A-Flex therapy we found a significant decrease of HOMA-IR -4,22 (95% Cl from -5,36 to -2,35; P=0,001), decrease AI -21,05 % (95% Cl from -26,5 to -17,4; P=0,001), decrease EFT -4,0 mm (95% Cl from-5,8 to -2,7; P=0,001) in severe OSA patients.Conclusions: The 12-month A-Flex therapy in moderate and severe OSA patients with AH has a significant therapeutic effect of stabilization systolic and diastolic blood pressure, level of blood lipids and epicardial fat thickness, level of endothelial dysfunction. The 12-month A-Flex therapy has to able to reduce the risks of cardiovascular events in moderate and severe OSA patients with acute metabolic manifestations.

Study Objective. To assess predictors of pneumonia in patients with acute myocardial infarction and acute ischemic stroke. Study Design: A retrospective analysis.Materials and methods. We reviewed archive data of 140 autopsy reports and medical histories of patients died from cardiovascular events to determine the frequency of pneumonia. The statistical analysis was used to derterman the connection between gender, age, duration of hospitalization, use of mechanical ventilation, central venous catheterization, presence of diabetes and COPD with the rate of pneumonia.Results and discussion. The study included 140 patients, of whom 84 (60,0%) with stroke in ischemic type 33 (23,6%) with stroke hemorrhagic type, and 23 (16.4%) with acute myocardial infarction. We examined the relationship of pneumonia with age, sex, duration of hospital stay, ventilator use, central venous catheterization, presence of diabetes and COPD. The average age of patients with pneumonia was 77±9 years, and without pneumonia 75±12 years. The average duration of hospitalization of the patients who died with pneumonia, was 13 (7,25; 25) days, and without pneumonia 3 (1; 10, and 25). Pneumonia developed in 39 (72,2%) males and 57 (66,3%) women. COPD was diagnosed in 98 (70%) patients. 19 patients (13,6%) patients have diabetes mellitus of the second type. CV catheterization was performed in 108 (77.1%) of the patient. In 83 (59.3%) patients during hospital treatment were on a artificial ventilation.Conclusion. The incidence of pneumonia increases depending on the duration of hospitalization, age, use of artificial ventilation. Gender, diabetes and COPD, central venous catheterization are not associated with the risk of pneumonia.

Aim. Evaluation of the efficacy and safety of the drug Aterixen® (XC221GI, 1-[2-(1-methylimidazole-4-yl)-ethyl]perhydroazine-2,6-dione), in the treatment of uncomplicated forms of influenza and other ARVI in adults. Materials and methods. The phase III clinical trial enrolled 260 people aged 18–65 years with mild and moderate forms of influenza or other ARVI. Patients were randomly assigned to two groups: in group 1 (n=130), patients were prescribed the drug Aterixen® in tablets of 100 mg 2 times a day for 5 days; in group 2 (n=130) – a placebo corresponding to the drug, in the same regimen. The primary endpoint of the efficacy assessment was the time in hours from the first administration of the drug to clinical improvement. The main efficacy analysis was performed in a population of patients with PCR-confirmed influenza or ARVI who completed the study according to the protocol (per protocol infected). Additionally, efficacy was evaluated in ITT and PP populations, including patients with both identified and undetected pathogen. The population for safety analysis included all patients, without exception, who were exposed to at least one exposure to the study drug or placebo. Results. A statistically significant superiority of the drug Aterixen® over placebo in primary endpoint was revealed in both the main and additional analysis in all studied populations: clinical improvement in the group of the studied drug occurred 24 hours faster compared with the placebo group. The evaluation of the effectiveness of secondary endpoints confirmed the superiority of the drug Aterixen® over placebo in terms of relief of catarrhal symptoms and symptoms of intoxication. A favorable safety profile of the drug has been demonstrated. Conclusion. The drug has demonstrated a favorable safety profile for use in outpatient practice. Aterixen® is an effective and safe treatment for influenza and other ARVI in adults.

Aim. To evaluate the efficacy and safety of OM-85 in the treatment of uncomplicated acute respiratory infections (ARI) in adults. Materials and methods. A double-blind, placebo-controlled, multicenter, randomized trial included 556 patients (18–60 years old) with mild and moderate ARI and negative results of polymerase chain reaction analysis for SARS-CoV-2 RNA and rapid test for influenza A and B viruses. Patients were randomized into two groups: in the first group (n=278), patients received OM-85 (Broncho-munal®) one capsule 7 mg/day for 10 days, while the second group (n=278) was treated with placebo in the same regimen. The primary endpoint was the dynamics of the severity of symptoms over 3, 5, 7 and 10 days of treatment according to the 21-item Wisconsin Upper Respiratory Symptom Survey (WURSS-21), which was assessed by the area under the curve. Secondary efficacy criteria were the dynamics of the severity of symptoms according to the Common Cold Questionnaire (CCQ), the time to the resolution of symptoms according to WURSS-21 and CCQ, the proportion of patients with body temperature below 37°C on each day of treatment, frequency of the need for systemic antibacterial therapy. Results. The superiority of OM-85 over placebo by primary endpoint was observed on the 5th, 7th and 10th days of treatment. OM-85 efficacy has also been proven by secondary criteria. OM-85 shortened the time until the symptoms of ARI resolved according to the WURSS-21 and CCQ, increased the proportion of patients with body temperature below 37°C by 2–9 days. The time needed to resolve the symptoms of disease in 20% of patients according to WURSS-21 was 7 and 9 days in patients taking OM-85 and placebo, respectively. Bacterial lysate increased the probability of complete disappearance of symptoms according to CCQ by 45.7% compared to placebo. The analysis of the frequency and severity of adverse events, laboratory tests, physical and instrumental examination results during treatment confirmed the good tolerability and safety of OM-85. Conclusion. The study confirmed the efficacy and safety of OM-85 in the complex treatment of ARI in adults.

Many years of experience in the use of ambroxol is based on its ability to regulate the basic mechanisms of physiological production and transport of bronchial mucus. The main indication for ambroxol is the mucolytic therapy of acute and chronic bronchopulmonary diseases associated with hypersecretion and impaired mucus transport. Ambroxol has a number of the following properties: high secretolytic activity (promotes mucus clearance, facilitates expectoration of sputum, reduces productive cough); anti-inflammatory and antioxidant activity; local analgesic (anesthetic) effect through the blockade of sodium channels of cell membranes. The effect of anesthesia of the mucous membranes is attributed to the new pharmacological action of ambroxol, useful in the treatment of acute respiratory tract infections. The efficacy and safety of ambroxol in clinical practice has been confirmed by half a century of experience in its administration. The purpose of this publication was an up-to-date assessment of the controversial and indisputable chemical, pharmacological, clinical data on the properties of ambroxol in the concept of modern recovery mucolytic therapy that can improve the therapy and prognosis of patients with tracheobronchial secretion hypersecretion, impaired mucociliary clearance and unproductive cough.