Аннотация
Настоящий обзор посвящен связи обструктивных апноэ во время сна с риском аритмий у детей. Фаза быстрого сна, во время которой у детей чаще всего фиксируются обструктивные апноэ, сопровождается повышенной вероятностью нарушений ритма сердца, а наличие обструктивных апноэ усугубляет эти риски. Гипоксемия, гиперкапния, изменения внутригрудного давления, реакция пробуждения на фоне апноэ и депривация сна, связанные с синдромом обструктивных апноэ во время сна (СОАС), приводят к симпатической активации, увеличению размеров левого предсердия и системному воспалению, что повышает риск аритмий. Типичным является формирования феномена брадикардии-тахикардии. Подобные эпизоды можно выявить при осуществлении суточного мониторирования ритма сердца. На фоне СОАС определяются выраженные нарушения автономной регуляции функции сердца. Усиление симпатической иннервации сердца сопровождается повышением дисперсии интервала QT и величины зубца Р, что может предрасполагать к развитию желудочковых и предсердных аритмий. Патологические апноэ могут сопровождаться эпизодами асистолии, возникновения эпизодов атриовентрикулярных блокад высоких степеней. Имеется необходимость комплексного обследования детей с подозрениями на нарушения ритма сердца и с предполагаемыми ночными апноэ, что важно для выбора оптимальной терапевтической тактики.
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Об авторах
Кельмансон Игорь Александрович, д-р мед. наук, профессор;
ORCID
