Sleep-related Breathing Disorders in Military Personnel During Combat Operations

Sleep-related breathing disorders are an urgent and multifaceted problem in clinical medicine. Obstructive sleep apnea syndrome (OSAS) can increase cardiovascular risk, initiate or contribute to the progression of hypertension, atherosclerosis, ischemic heart disease, and complications such as heart failure, arrhythmia, myocardial infarction, and stroke. The objective: to analyze the features of the course of OSAS in military personnel during combat operations. Materials and methods. The study included 27 military personnel with OSAS who have received treatment at the Main Military Clinical Hospital. All study participants were male persons, with an average age of 42.7±3.4 years. Patients had a comprehensive examination, subjective sleepiness was assessed using the Epworth sleepiness scale questionnaire, and polysomnography was performed. All patients were examined for concomitant comorbid pathology. Results. It was determined that the average duration of OSAS was 6.4±2.1 years. The main complaints of military personnel were daytime drowsiness and fatigue, short-term falling asleep during the performance of official duties at rest and driving a car, headache, nighttime sleep disorders with frequent awakenings, dry mouth after awakening, impaired memory and concentration, decreased libido, emotional disorders, awakening with a feeling of shortness of breath, nocturia, palpitations and weight gain. The results of the study indicate that OSAS in military personnel has a high comorbidity, since one patient may have two or more comorbid diseases. Daily monitoring of blood pressure by Holter established that 22 (81.5%) individuals have the “non dipper” type, and 5 (18.5%) have the “dipper” type. In patients with stage II arterial hypertension with OSAS, an increased level of office systolic blood pressure, as well as its average daily, daytime and nighttime values, was determined. 12 (44.4%) of the examined persons were diagnosed with chronic obstructive pulmonary disease (COPD). During polysomnography the significant changes in the respiratory system were detected, the number and duration of respiratory events progressed with the severity of OSAS. Among the examined military personnel with OSAS the daytime sleepiness index was 7.6±0.1 points. Conclusions. In military personnel OSAS is an extremely important problem, a potentially dangerous factor for life and effective performance of official duties, which can lead to a decreased concentration of attention and injuries. The combined course of COPD and OSAS leads to severe hypoxia and hypercapnia, pulmonary hypertension, and a high risk of nocturnal death.