НАРУШЕНИЯ СНА И ХРОНИЧЕСКИЙ СТРЕСС КАК ФАКТОРЫ РИСКА СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИИ

Aim. To conduct an assessment of the impact of chronic sleep onset/maintenance disorders and clinical-instrumental markers of occupational stress as predictors and/or risk factors for adverse course of cardiovascular disorders in intellect-related work, and to define ways of prevention management. Material and methods. In 2008-2009yy the group was created, consisted of 167 patients, employed in intellect-related work (85 men, 82 women, mean age 51,7+7,5 y.), not having sleep disordered breathing. 49 patients had confirmed CHD diagnosis, 55 — hypertension disease of 2-3 stage. Controls were 63 persons. Baseline investigation included collection of clinical and anamnestic data, search for psychosocial markers of occupational stress, sleep disorders diagnostics, what included nocturnal polysomnographic study. Second assessment was done in 2012-2013yy and included clinical cardiovascular outcomes collection. Results. Chronic insomnia was found in 30 (61%) patients with CHD, in 33 (60%) with hypertension disease and in 29 (46%) controls. Elevated levels of occupational stress, defined within the model “effort-reward”, were found in 26 (53%) of CHD patients, in 29 (53%) with AH, in 25 (40%) of controls. In cardiovascular patients and disordered sleep there were instrumental findings of disordered sleep (decrease of sleep effectiveness, % of slow-wave sleep) and prevalence of stimulating influences by EEG. By the data of prospective observation the presence of chronic insomnia, at baseline, associated with increased risk of new onsets of hypertension disease (OR=2,1) and CHD (OR=1,9). Conclusion. Disordered sleep onset and sleep maintenance can be treated as indicators of chronic stress in cardiovascular patients. Programs of cardiological rehabilitation shall include the actions for stress and sleep disorders screening.