GDF11 (Protein of Juvenility) and GDF15 (Protein of Senility) in the Plasma of Patients with Sleep Apnea Syndrome: a Pilot Study.

We performed a matched-pair analysis of the content of GDF11 and GDF15 proteins in the plasma of patients (56 middle-aged men) with obstructive sleep apnea syndrome (OSAS) and healthy volunteers (27 men with no complaints of sleep disorders). The groups were comparable in terms of age and presence of chronic diseases. No statistically significant differences in GDF11 content in the studied groups were revealed, while the content of GDF15 in the OSAS group was 1.3 times higher. These results require further research from the viewpoint of geriatric somnology and molecular biology.

The State of the LPO-AOD System and the Relative Length of Telomeric Repeats in the Chromosomes of Blood Leukocytes in Obstructive Sleep Apnea Syndrome.

We analyzed the relative length of telomeric repeats in peripheral blood leukocytes and indicators of oxidative stress in 32 men (mean age 51.2±3.1 years) with obstructive sleep apnea syndrome (OSAS). The control group consisted of volunteers without OSAS. The relative length of telomeres was determined in a DNA sample isolated from venous whole blood samples. The length of telomeric repeats of chromosomes was determined using quantitative real-time PCR (3 times for each DNA sample); albumin served as an internal control. The intensity of LPO processes and antioxidant protection was assessed by conventional spectrophotometric methods. It was found that in patients with OSAS, the relative length of telomeric repeats was lower by 48%, the levels of substrates and products of LPO were higher (double bonds and diene conjugates by 34 and 19%, respectively), and antioxidant protection indicators were lower (concentrations of fat-soluble vitamins α-tocopherol and retinol by 18 and 19.3%, respectively, total antioxidant activity by 32.9%) than in volunteers of the control group. Thus, we can conclude that the nucleotide sequences are reduced in patients with OSAS under conditions of intensified free radical oxidation.

Features of the EEG Pattern of Sleep Spindles and Its Diagnostic Significance in Ontogeny.

Analysis of the microstructure of sleep using extended EEG monitoring can provide deep understanding of the neuronal activity of the brain. Sleep spindles (SS) are one of the main EEG patterns occurring during the non-rapid eye movement sleep. SS reflect the process of synchronization and provide sleep initiation and maintenance by suppressing sensory information. SS are associated with a wide range of brain functions, such as memory and neuroplasticity, general intelligence and cognitive performance, which undergo various changes throughout the life. In this review we discuss the features of the formation and regression of SS in humans during ontogeny on the basis of published data of the last 5-6 years and fundamental results of previous studies at the Scientific Centre for Family Health and Human Reproduction Problems that formed the basis of the modern study of neurophysiological phenomena of the wakefulness and sleep. The search for diagnostic patterns and prognostic markers of the pathology of higher nervous activity remains a priority in fundamental studies and medical practice. Modern methods for studying sleep and its EEG patterns are the next step in understanding the neurophysiological aspects of the sleep-wake cycle. This will open prospects for predicting postnatal maturation, understanding the mechanisms of brain neuroplasticity in the "sleep-wakefulness" continuum, which is one of the tasks of modern somnology and neurophysiology.

Serum Serotonin as a Biomarker of the Efficacy of PAP-Therapy in Sleep Apnea Syndrome.

Serum serotonin levels were determined by HPLC in 30 patients with diagnosed obstructive sleep apnea syndrome before and after 3-month course of PAP-therapy and in 14 subjects without obstructive sleep apnea symptoms. It was found that elimination of hypoxic conditions was associated with an increase in serotonin level. The results demonstrate the effectiveness of PAP-therapy during sleep and allow assessing the role of serotonin as a potential biomarker of intermittent hypoxia during sleep.

[Impact of CPAP therapy on erectile function during sleep and testosterone level in men with sleep apnea syndrome].

The article presents the results of a polysomnographic study with simultaneous monitoring spontaneous nocturnal erections - Nocturnal Penile Tumescences (NPT) in 69 men with age-related androgen deficiency (AAD). Of these, 45 patients were diagnosed with obstructive sleep apnea syndrome (OSAS). In 34 of the 45 patients with OSAS, regimens of non-invasive ventilation with positive-positive airway pressure (CPAP) were selected. Titration was carried out using automatic CPAP-devices for 2 months. The control group (n=24) comprised men with AAD, matched by the "copy-pair" type without clinical manifestations of respiratory disturbances during sleep. Extreme fragmentation of sleep with a significant predominance of the 1st and 2nd stages of the slow sleep phase, the deficiency of deep sleep stages and the significant shortening of the fast sleep phase was leveled by using a constant positive pressure in the upper respiratory tract. CPAP-therapy produced the phenomenon of a "rebound" of slow-wave sleep and fast-sleep phase. Before treatment, men with OSAS had a disruptive pattern of NPT (quantitative and qualitative characteristics). CPAP-therapy resulted in its recovery and maximum preservation relative to fast sleep phase time boundaries. However, the trend towards increasing testosterone levels was not significant, which requires additional testosterone replacement therapy concurrently with CPAP therapy in patients with OSAS and AAD.

[Gender characteristics of the structural organization of sleep in obstructive sleep apnea syndrome]. / Gendernye osobennosti strukturnoi organizatsii sna pri sindrome apnoe.

AIM: To reveal gender characteristics of the sleep structure in obstructive sleep apnea syndrome (OSAS) during polysomnographic monitoring (PSGM). SUBJECTS AND METHODS: According to the results of a pre-survey using an apnea screening questionnaire, the investigation included 58 women (body mass index (BMI), 38.2±2.1 kg/m2) and 75 men (BMI, 34.2±1.8 kg/m2), aged 50-55 years, who complained about snoring, sleep apnea, and daytime hypersomnia. Copy-pair groups were formed and compared after objectively confirming the diagnosis by PSGM made at a specialized sleep laboratory, by applying the GRASS-TELEFACTOR Twin PSG system (Comet) with an integrated SPM-1 sleep module (USA) in accordance with the standard procedure. The International Sleep Disorder Classification (2005) was used to diagnose apnea and to estimate its severity. RESULTS: According to the results of PSGM, the men and women were divided into 3 groups, by using the generally accepted OSAS severity scale. Comparative analysis revealed differences in sleep structure parameters with the equal severity of OSAS in the men and women. These differences were characterized by a more marked fragmentariness, impaired cyclicity, and the appearance of the basic specific phenomenon of impaired integrated activity of somnogenic structures - an alpha-delta sleep phenomenon in the men versus the women. There were increases in the time of rapid eye movement (REM) sleep, in that of awakening at night after falling asleep, and in sleep latency in the women with a simultaneous decrease in the total effectiveness of sleep compared to that in the men with the equal-severity OSAS. CONCLUSION: The found gender differences in the sleep structure may be ascribed to the compensatory mechanisms in the function of brain somnogenic structures in the women and the preponderance of REM sleep is a compensatory adaptive response of the sleep homeostatic system, which necessitates further investigations in this area.

[Features of the sleep pattern during pregnancy].

AIM: To evaluate the qualitative characteristics of a sleep in pregnant women in the 3rd term of the physiological pregnancy by a questionnaire survey. MATERIALS AND METHODS: We have demonstrated questionnaire survey data of 400 pregnant women (mean age 27.5 +/- 8.2 years) in the 3rd term of pregnancy. Questioning conducted using the scale PSQI (PITTSBURGH SLEEP QUALITY INDEX--Pittsburgh Sleep Quality Assessment Questionnaire), EPWORTH SLEEPINESS SCALE (sleepiness questionnaire Epfort's) and screening questionnaire to identify obstructive sleep apnea. RESULTS: We have determined that 78% of pregnant women to complain about sleep disorders, namely obstructive sleep disordered breathing, insomnia, "restless legs" syndrome, and combinations thereof. The frequency of sleep disorders increases as pregnancy progresses. Obstructive sleep disordered breathing increases with 10.12% in the 1st term to 31.7% in the 3rd term, insomnia--from 14.3% in the 1st term to 37.6% in the 3rd term. In pregnancy increases of sleep latency (from 14.3 to 44.9 minutes), and reduced the duration of a sleep (from 8.7 to 7.8 hours). CONCLUSIONS: high frequency of sleep disorders in pregnancy requires early pathogenetic prevention of pathological conditions, both in the mother and in the fetus.

[Evaluation of erectile function during the night in men with obstructive sleep apnea syndrome: new possibilities of modern sleep medicine].

Currently, the relationship between the sleep and erectile function (EF) is not in doubt; therefore, evaluation of this relationship in the context of sleep medicine (somnology) is the most informative diagnostic method. The article presents the results of polysomnography with the option of simultaneous monitoring of spontaneous episodes of nocturnal erections in 51 men aged 46-55 years without complaints of violation of the EF. The main group (n = 37) consisted of patients with obstructive sleep apnea syndrome (OSAS). The violation of pattern (quantitative and qualitative characteristics) of nocturnal episodes of spontaneous erections in this group of men was revealed, which was regarded as the initial (pre-clinical) manifestation of erectile dysfunction. Thus, modern diagnostic capabilities of sleep medicine allow to effectively evaluate the EF in patients with OSAS and timely assign pathogenetically justified therapy.

[The experience with the application of the non-medication methods for the treatment of essential arterial hypertension in the adolescents presenting with obstructive sleep apnea/hypopnea syndrome].

The present study was designed to estimate the effectiveness of non-invasive auxiliary lung ventilation under continuous positive airway pressure (CPAP therapy) and phototherapy applied for the treatment of adolescents presenting with essential arterial hypertension and obstructive sleep apnea/hypopnea. It was shown that CPAP therapy decreased the level of arterial pressure (AP) either to normal or to high normal values in accordance with the patients' gender and age. It was confirmed that phototherapy produced beneficial effect on the system of circadian rhythms in the patients with essential hypertension. These findings give reason to recommend the combined application of the above methods for the treatment of adolescents with essential hypertension and obstructive sleep apnea/hypopnea. The proposed treatment makes it possible to decrease arterial pressure due to the correction of obstructive breathing disorders in sleep and to normalize the circadian rhythm system in the adolescents suffering from essential hypertension and obstructive sleep apnea/hypopnea. The clinical application of this method would permit to reduce morbidity, the incidence of disability, and mortality from complications developing in adulthood.

[Changes the level of differentiating growth factor - GDF 15 in patients with sleep apnea syndrome after aPAP-therapy: pilot study]. / Izmenenie urovnya differentsirovochnogo faktora rosta ­ GDF 15 u patsientov s sindromom apnoe sna na fone aPAP-terapii: pilotnoe issledovanie.

OBJECTIVE: Comparative assessment of the level of differentiating growth factor 15 (GDF 15 ) against the background of a 6-month course of respiratory support in the mode of automatic positive pressure in the airways therapy (aPAP therapy) in patients with obstructive sleep apnea syndrome (OSA). MATERIAL AND METHODS: 59 men participated in the study, the average age was 51.9±2.4 years. The main group (MG1) consisted of 30 patients with a verified diagnosis of moderate OSA. 29 men of comparable age and body weight made up the control group (CG) without an objectively confirmed diagnosis of OSA. After the stage of introduction into the study, the type of respiratory support with individual pressure settings was selected for patients with MG1. After 6 months of aPAP therapy with high compliance (at least 85%), the same patients who made up MG2 after treatment underwent repeated polysomnography (PSG) and the GDF 15 content was evaluated. Methods: questionnaire, examination, polysomnography, enzyme immunoassay of blood serum to determine the content of GDF 15. RESULTS: A 6-month course of aPAP therapy with a high degree of compliance significantly improved the sleep structure and breathing pattern: the representation of NREM 3 increased from 79.2±15.6 to 102.6±21.6 minutes and the REM phase from 56.9± 13.6 to 115.6±26.8. Episodes of apnea were eliminated - apnea-hypopnea index decreased from 21.1 [17.3; 39.1] to 2.5 [1.8; 4.6] and the average values of SaO2 increased from 85.9% to 91.5%. At the same time, a statistically significant excess of GDF 15 was revealed in MG1 - 20.4 [14.16; 31.71] and MG2 - 17.2 [13.63; 24.44]) in comparison with CG - 13.65 [10.7; 17.09]. Despite the lack of statistical significance, a change in the level of GDF 15 was revealed in the form of a decrease in its concentration after a 6-month course of aPAP therapy. CONCLUSION: A 6-month course of aPAP therapy made it possible to eliminate intermittent nocturnal hypoxia and improve sleep structure in patients with OSA, as well as reduce the content of GDF 15 protein in blood serum in patients with OSA. However, the tendency to decrease the content of this protein, despite the lack of statistical reliability, confirms the effectiveness of OSA therapy and the possibility of preventing early and pathological aging from the standpoint of somnology and molecular biogerontology.

Pathogenic role of melatonin in sleep disorders in menopausal women.

The data on circadian rhythms of melatonin secretion in women of perimenopausal (n=39) and postmenopausal (n=52) age are presented. Each group was divided into control (without sleep disorders) and main group (with sleep disorders). The saliva was collected 4 times a day (6.00-7.00, 12.00-13.00, 18.00-19.00, 23.00-24.00). The study revealed an association between sleep disorders and decreased level of melatonin only in women of perimenopausal age.

[Activity of the telomerase complex before and after CPAP therapy in patients with obstructive sleep apnea syndrome]. / Aktivnost' telomeraznogo kompleksa na fone SIPAP-terapii u patsientov s sindromom obstruktivnogo apnoe sna.

OBJECTIVE: To evaluate changes in the activity of the telomerase complex in patients with obstructive sleep apnea (OSA) before and after continuous positive airway pressure (CPAP) therapy. MATERIAL AND METHODS: In accordance with the objectives of the stages of the study of telomers-telomerase relationships, we maintained the unified design of the study described earlier. The main group 1 (MG1), n=35, consisted of men, aged 53.4 [45.5-60.1] years with characteristic complaints indicating of OSA. The main group 2 (MG2) included the same patients before and after 6 months of CPAP therapy. Blood sampling was performed after the first diagnostic polysomnography (PSG) and after 6 months of CPAP in the morning after the second PSG. The control group (CG) consisted of 26 men, comparable in age and the presence of chronic diseases. Questionnaire, PSG and blood sampling were conducted in CG as well. All participants signed an informed consent. RESULTS: As a result of the STOP-BANG questionnaire conducted before PSG, all patients in the MG1 had scores from 5 to 8. The scores on the Epworth scale were more than 5 points. In the MG2 apnea-hypopnea index decreased from 20.1 to 6.4 ev/hour, the desaturation index decreased from 15.6 to 7.1 ev/hour after 6 months of CPAP. Statistically significant differences in changes in the activity of the telomerase complex were revealed, which after treatment significantly exceed the values of these indicators before treatment. So, telomerase reverse transcriptase value was 0.04 (0.009; 0.06) in the MG1, after treatment it was 0.07 (0.06; 0.09) in the MG2 and 0.134 (0.009; 0.18) in the CG. Telomerase RNA subunit TER1 values were 0.06 (0.03; 0.09), 0.07 (0.05; 0.09) and 0.136 (0.04; 0.17), respectively. However, despite the activation of the telomerase complex during CPAP therapy in patients with OSA, in the CG its activity is significantly higher in comparison with the MG1 and MG2. CONCLUSION: In OSA accompanied by intermittent hypoxia, a decrease in the activity of the telomerase complex was shown. Elimination of nocturnal hypoxia and improvement of breathing during sleep is accompanied by an increase in the activity of the components of the telomerase complex.

[Changes in the telomeres length in patients with obstructive sleep apnea after continuous positive airway pressure therapy: a pilot study]. / Izmenenie otnositel'noi dliny telomer u patsientov s sindromom obstruktivnogo apnoe sna na fone SIPAP-terapii: pilotnoe issledovanie.

OBJECTIVE: To evaluate a relative telomere length in patients with obstructive sleep apnea (OSA) before and after a 6-month course of continuous positive airway pressure (CPAP) therapy. MATERIAL AND METHODS: Seventy-five men participated in the study, including 50 men with OSA (the main group 1) and 25 men without OSA (the control group). The average age in the total group was 53.4±3.6 years. Thirty-five men completed the study (the main group 2). According to the design, night polysomnography (PSG) was performed for all the subjects, blood sampling to assess the length of telomeres was carried out in the morning according to the standard method. The values of the relative telomere length were obtained using the difference between the values of the threshold cycles for telomeric DNA and the reference gene albumin (∆CCt). After clarifying the diagnosis, CPAP was applied for 6 months. RESULTS: Statistically significant indicators of PSG were revealed: a decrease in NREM 3 in patients with OSA compared to controls (89.3±15.8 versus 150±23.4 minutes), an increase in NREM1-2 in OSA (296.2±31.1 and 170.1±24.5, respectively), REM was 84.6±15.4 in the main group and 118.5±19.5 in the control group. CPAP therapy conducted for 6 months (at least 4-5 nights a week, lasting at least 5-6 hours of night sleep) demonstrated a significant improvement in the qualitative and quantitative parameters of sleep. In patients of the main group 1, there is a shortening of the telomere length compared with the control group (p<0.001). With the elimination of hypoxia and improvement of the structure of sleep after CPAP, there was an increase in the telomere lengths in the main group 1 from 0.28 [0.24-0.29] to 0.32 [0.30-0.34] in the main group 2 (p=0.03). The telomers length in the control group was 0.53 [0.50-0.55]. CONCLUSION: Intermittent hypoxia and fragmentation of sleep in OSA leads to shortening of telomeres. CPAP, by eliminating the pathophysiological triggers of OSA, contributes to an increase in telomeres lengths and can slow down the premature aging in OSA.

[Novel coronavirus disease (COVID-19) and obstructive sleep apnea: age aspects of comorbidity]. / Novaya koronavirusnaya infektsiya (COVID-19) i sindrom obstruktivnogo apnoe sna: vozrastnye aspekty komorbidnosti.

In connection with the spread of the novel coronavirus infection (COVID-19) pandemic and the increase in the development of severe acute respiratory syndrome, works are published around the world that determined the risk factors for complications and poor outcomes in this disease. Among the main comorbidities in COVID-19, scientists distinguish hypertension, diabetes, obesity, etc. Recently, more and more physicians and researchers are concerned about the high frequency of severe and critical complications of COVID-19 in patients with obstructive sleep apnea (OSA). In this review, we present some data on COVID-19 and OSA in the age aspect, show the general pathophysiological pathways leading to increased systemic inflammation and adverse consequences in the comorbid course of these diseases. Special attention is paid to such studies in the pediatric population, but only a few works of foreign scientists were found that did not reveal the essence of the problem under discussion, which requires further research in this area.

[Sleep apnea syndrome, pregnancy and fetal condition]. / Sindrom obstruktivnogo apnoe sna, beremennost' i sostoyanie ploda.

OBJECTIVE: To assess fetal cardiac activity with simultaneous polysomnographic (PSG) study of pregnancy with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Forty-nine women, aged 18-30 years, 30-34 weeks pregnant, complaining of snoring, with a positive rating in 2 and/or 3 sections of the Berlin Sleep Questionnaire were included in the study. Sixteen pregnant women with the corresponding gestational age, without complaints of snoring, made up the control group. All participants underwent PSG monitoring and fetal cardiotocography (CTG) according to standard techniques. RESULTS: PSG results demonstrate significant changes in sleep patterns in pregnant women with OSAS. There is a significant reduction in SWS 3, REM. High AHI, accompanied by desaturation and the appearance of activation EEG- patterns of cyclic alternations are characterized the sleep of pregnant women with OSAS. Analysis of CTG results shows that the average values of the basal rhythm are statistically higher in women with OSAS than in the control group. Also, the indicators of the amplitude of the oscillations, the frequency of oscillations and the number of movements in 30 minutes are statistically significantly different. Reaction of the fetus to episodes of apnea in the form of active perturbation, changes in heart rate as bradycardia (to 105-110 beats per minute) or tachycardia (to 155-160 beats per minute) compared to basal level (140 beats per minute) are noted. CONCLUSION: OSAS during nocturnal sleep in pregnant women causes the changes in motor activity and cardiac activity of the fetus that indicates fetal hypoxemia.

[Evaluation of the structural organization of sleep in obstructive apnea syndrome from the perspective of modern pathophysiology]. / Otsenka osobennostei strukturnoi organizatsii sna pri sindrome obstruktivnogo apnoe s pozitsii sovremennoi patofiziologii.

OBJECTIVE: To evaluate the features of structural organization of sleep in men 35-55 years of age with varying degrees of severity and duration of clinical manifestations of obstructive sleep apnea syndrome (OSAS) from the perspective of modern pathophysiology. MATERIAL AND METHODS: The study included 49 male patients, aged 35-55 years (average age was 43.4±9.2 years), with a body mass index (BMI) of 33.64±1.2 kg/m2 with complaints of snoring of varying degrees of intensity, daytime sleepiness, arrest of breathing during sleep (according to others). The control group consisted of 15 healthy men who did not have complaints of sleep disorders and clinical manifestations of OSAS. The Pittsburgh sleep quality index (PSQI) questionnaire and polysomnographic monitoring study (PSG) were used. According to the results of the polysomnographic study, all patients were divided into 2 subgroups: 12 men of group 1with moderate OSAS (duration of clinical manifestations 4.5±1.0 years) and 37 men of group 2 with severe OSAS (duration 1.5±1.5 years). RESULTS: A decrease in the sleep quality was detected in 61.9% of patients in the group 1 and 89.2% of patients in the group 2. Significantly higher scores for the components of «sleep disturbance¼ and «daytime dysfunction¼ in patients with a longer duration of clinical manifestations were detected. Changes in the structure of sleep were identified in patients compared with controls. A statistically significant increase in WASO led to the reduction of sleep efficiency. In patients of group 2, a deficiency of the deep stages and REM-sleep was determined. There was a significant increase in the number of arousals in patients of both groups relative to the controls. Moreover, significant between-group differences were found. CONCLUSION: The short duration of OSAS symptoms causes a restructuring of the physiological system of sleep homeostasis to a different level of functioning with compensatory hyperfunction of the structures responsible for REM sleep and a decrease (economization) in the activity of anabolic processes during sleep due to a decrease in SWS, which is a characteristic feature of long-term adaptation. Severe course of OSAS leads to the appearance of specific phenomena of gross structural disorganization of sleep - «alpha-delta sleep¼ and disruption of its segmental organization, which shows the depletion and disruption of compensatory-adaptive mechanisms in the system of sleep homeostasis, disintegration and transformation of functional physiological system in the pathological condition.

[Characteristics of sleep structure in schoolchildren with high intellectual abilities]. / Osobennosti strukturnoi organizatsii sna u shkol'nikov s vysokimi intellektual'nymi sposobnostiami.

AIM: To study characteristics of sleep structure based on polysomnography (PSG) data of intellectually gifted schoolchildren. MATERIAL AND METHODS: Forty-four 8-9 grade schoolchildren of the boarding school were examined. In the first stage, the level of intellectual development was assessed with Raven's Progressive Matrices. An analysis of medical history and clinical examination were performed as well. Based on the result of testing, the adolescents were divided into medium intelligence group (n=15) and high intelligence group (n=29). The second stage included PSG examination. RESULTS AND CONCLUSION: There was a trend towards an increase in sleep latency with a significant decrease of deep sleep, a significant decrease in REM-sleep latency and an increase in the number of REM-sleep episodes in the high intelligence group. No significant differences in waking after sleep onset, number of arousals (EEG activations) and respiratory events, and oxygen saturation levels were identified. The characteristics of PSG in intellectually gifted schoolchildren should be considered as a compensatory and adaptive reaction in response to constant increased intellectual loads and stressful situations as risk factors for psychosomatic disorders.

[Pathophysiological aspects of neuro-endocrine regulation system in patients with obstructive sleep apnea syndrome]. / Patofiziologicheskie aspekty funktsionirovaniia sistemy neiroéndokrinnoi reguliatsii pri sindrome obstruktivnogo apnoé sna.

AIM: To reveal the changes in the pituitary-thyroid, pituitary-gonadal, adrenal components and in the prolactinergic system of neuroendocrine regulation in patients with severe obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: The study involved 51 men aged 46-55 years. The main group (BG) included 37 patients with severe OSAS. The duration of clinical manifestations of OSAS was 10.5±1.5 years. OSAS was verified on the basis of clinical and functional studies and polysomnographic monitoring in accordance with the AASM criteria (2014). The control group (CG) consisted of 14 age-matched men without sleep-disordered breathing. The body mass index in BG was 34.2±1.8 compared to 28.2±2.1 kg/m2 in CG. Serum concentrations of thyroid-stimulating hormone (TTG), free thyroxine (T4), triiodothyronine (T3), cortisol, prolactin, testosterone, luteonizing (LH) and follicle-stimulating (FSH) hormones were determined by the immunoradiological method using the standard DIA test system (Russia) and the analyzer 'Immunotest-800'. RESULTS: Patients with severe OSAS had decreased concentration of free thyroxine (T4) and decreased activity of thyroid stimulating hormone (TSH) (р<0.001), increased concentration of prolactin and cortisol (р<0.001), decreased concentration of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone compared to the controls (р<0.001). CONCLUSION: The changes in the hypothalamic-pituitary-gonadal system are a manifestation of disturbances of the mechanisms of self-regulation and compensation that indicates the presence of maladaptive reactions of the neuroendocrine system.

[Obstructive sleep apnea syndrome and age-related hypohonadism]. / Sindrom obstruktivnogo apnoé sna i vozrastnoi gipogonadizm.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a common disease that causes a different spectrum of life processes violations in the continuum of 'sleep-wakefulness'. OSAS in combination with age-specific hypogonadism as a systemic pathology requires certain interdisciplinary approaches involving both the correction of the obstruction, and testosterone therapy in men with hypogonadism. AIM: Assessment of the effect of combined use of CPAP (Continuous Positive Airway Pressure) and testosterone replacement therapy (transdermal form - Androgel) on indicators of polysomnography monitoring (PSG) with simultaneous study of erectile function and testosterone secretion. MATERIAL AND METHODS: 26 men with OSAS and andropause (mean age - 46,1±8,4 years, BMI - 35,2±4,6 kg/m2) were examined. All patients were divided into 2 groups: men with therapy CPAP (n=14); men with combination therapy CPAP and Androgel (50 mg 1 times a day) (n=12). CPAP was carried out by automatic apparatus: Prisma 20A ('Weinemann', Germany) and iSleep 20i ('Breas', Sweden). Duration of therapy in both groups was 2 months. RESULTS: There were no statistically significant differences in the baseline characteristics of the physical examination, the level of total testosterone, PSG and nocturnal penile patterns in both groups of patients. After combination therapy (CPAP and Androgel) in men found the increase of total testosterone levels by 2 times (p<0,05) and improvement in indicators of altered nocturnal penile erection episodes (Tup, Tmax, Tm/R, Tup/R, the total number of NPT (p<0,05)) compared with similar parameters in men with only on CPAP-therapy was found. Indicators of the objective status were improved, although there were no changes in PSG characteristics in both groups. CONCLUSION: The results of this study indicate greater efficiency of the combined method of treatment (CPAP+Androgel) in patients with OSAS and andropause.