Aim. To study the prevalence and risk factors (RF) for hospital-acquired pneumonia (HAP) after on-pump cardiac surgery in a modern cohort of patients.Material and methods. This retrospective analysis of the medical records of cardiovascular surgery patients, operated on in the period from January 1, 2022 to December 31, 2022. The study consistently included 417 patients who underwent on-pump cardiac surgery. The incidence and timing of HAP development were assessed. The influence of the main demographic, clinical, and perioperative factors on HAP risk was studied.Results. The pneumonia prevalence per year was 27,6%, including after the Frozen Elephant Trunk (FET) procedure — 32%, after coronary artery bypass grafting (CABG) — 29,5%, after combined CABG and heart valve surgery — 26,2%, after isolated valve surgery — 25,9%, after thoracic aortic hemiarch replacement — 19,5%. Pneumonia developed on the 4,6±2,9 day after surgery. The risk of pneumonia increased with atrial fibrillation (AF) before surgery (odds ratio (OR) 3,17; 95% confidence interval (CI): 1,67; 6,02, p=0,0002), on-pump duration (OR 1,01; 95% CI: 1,00; 1,01; p=0,0006), aortic cross-clamping (OR 1,01; 95% CI: 1,00; 1,01; p=0,0002) and mechanical ventilation (OR 1,03; 95% CI: 1,01; 1,05; p=0,005). Pneumonia predictors were on-pump duration ≥96 min (sensitivity 67,7%, specificity 64,6%, AUC=0,681, p=0,0006) and mechanical ventilation ≥14 h (sensitivity 63,1%, specificity 69,3%, AUC=0,641, p=0,005), as well as preoperative AF (sensitivity 61%, specificity 75%, p=0,0002).Conclusion. Preoperative AF, on-pump duration ≥96 min and mechanical ventilation ≥14 h serve as categorical and quantitative predictors of postoperative HAP in a modern cohort of patients.

Introduction: Organoprotective effects of perioperative nitric oxide delivery towards the heart and kidneys have been demonstrated many times in cardiac surgery but information about its ability to prevent respiratory complications is extremely limited. Objective: This study aimed at evaluation of the efficacy and the safety of perioperative nitric oxide delivery for preventing respiratory complications during cardiac surgeries involving cardiopulmonary bypass in patients with an increased risk of adverse respiratory events and the identification of the risk factors towards postoperative acute respiratory. Methods: A prospective randomised controlled study included 132 cardiac surgical patients with increased risk of postoperative respiratory failure who were divided into two groups. The main group received nitric oxide at a concentration of 80 ppm throughout the operation and the first 6 hours at the postoperative period. The primary endpoint was the ratio of the partial pressure of oxygen in arterial blood to the fraction of inspired oxygen in 24 hours after the operation. Results: Patients receiving perioperative nitric oxide demonstrated significant improvements in oxygenation (paO2/FiO2 ratio, p < 0.001) in 24 hour post-surgery period that was associated with a decrease in pulmonary shunt fraction (p < 0.001), a decline of acute respiratory failure incidence (p = 0.042), and postoperative pneumonia (p = 0.013). Delivery of nitric oxide did not entail an increase in methemoglobin concentration above 5% and nitrogen dioxide above 3 ppm. In 24 h after surgery, revealed cases of acute respiratory failure were associated with blood transfusion (p = 0.033), as well as an excess of cardiopulmonary bypass duration of more than 97 min and mechanical ventilator duration of more than 628 min. Conclusion: Perioperative delivery of 80 ppm nitric oxide in cardiac surgeries involving cardiopulmonary bypass is safe and effective since it results in improved pulmonary oxygenating function and decreased pulmonary complications. In patients with an increased risk of adverse respiratory events, identified risk factors of acute respiratory failure include blood transfusion, prolonged cardiopulmonary bypass, and extended mechanical ventilation. Received 23 September 2024. Revised 2 October 2024. Accepted 7 October 2024. FundingThe study was carried out within the framework of the state assignment under the topic of basic scientific research No. 122123000017-3. Conflict of interestsThe authors declare no conflict of interest. Contribution of the authorsConception and study design: N.O. Kamenshchikov, I.V. Kravchenko, Yu.K. Podoksenov, B.N. KozlovData collection and analysis: I.V. Kravchenko, M.A. Tyo, E.A. Churilina, M.S. Kozulin, A.M. Gusakova, T.P. KalashnikovaStatistical analysis: I.V. Kravchenko, Yu.K. PodoksenovDrafting the article: I.V. Kravchenko, Yu.K. PodoksenovCritical revision of the article: N.O. Kamenshchikov, B.N. KozlovFinal approval of the version to be published: I.V. Kravchenko, Yu.K. Podoksenov, M.A. Tyo, T.P. Kalashnikova, E.A. Churilina, M.S. Kozulin, A.M. Gusakova, B.N. Kozlov, N.O. Kamenshchikov

Актуальность. В кардиохирургии многократно продемонстрирован органопротективный эффект периоперационной доставки оксида азота в отношении сердца и почек, однако знания о ее способности профилактировать респираторные осложнения крайне ограниченны. Цель. Изучить эффективность периоперационной доставки оксида азота в профилактике респираторных осложнений при кардиохирургических операциях в условиях искусственного кровообращения у пациентов с повышенным риском неблагоприятных респираторных событий, доказать ее безопасность и выявить факторы риска послеоперационной острой дыхательной недостаточности. Методы. В проспективное рандомизированное контролируемое исследование включили 132 кардиохирургических пациента с повышенным риском неблагоприятных респираторных событий и разделили на две группы. Субъектам основной группы доставляли оксид азота в концентрации 80 ppm в течение всей операции и первых 6 ч послеоперационного периода. Первичной конечной точкой была величина отношения парциального давления кислорода в артериальной крови к фракции вдыхаемого кислорода через 24 ч после операции. Результаты. Доставка оксида азота приводила к увеличению отношения парциального давления кислорода в артериальной крови к фракции вдыхаемого кислорода (p < 0,001) через 24 ч после операции, была ассоциирована со снижением фракции легочного шунта (p < 0,001), частоты острой дыхательной недостаточности (p = 0,042) и послеоперационной пневмонии (p = 0,013). Доставка оксида азота не сопровождалась повышением уровня метгемоглобина ≥ 5 % и концентрации диоксида азота ≥ 3 ppm. Частота острой дыхательной недостаточности через 24 ч после операции была связана с гемотрансфузией (p = 0,033), продолжительностью искусственного кровообращения более 97 мин и продолжительностью искусственной вентиляции легких более 628 мин. Заключение. Периоперационная доставка оксида азота 80 ppm при кардиохирургических операциях в условиях искусственного кровообращения безопасна, улучшает оксигенирующую функцию легких и ассоциирована с уменьшением частоты легочных осложнений. Гемотрансфузия, продолжительность искусственного кровообращения и продолжительность искусственной вентиляции легких являются факторами риска острой дыхательной недостаточности через 24 ч после кардиохирургических операций у пациентов с повышенным риском неблагоприятных респираторных событий. Поступила в редакцию 23 сентября 2024 г. Исправлена 2 октября 2024 г. Принята к печати 7 октября 2024 г. Финансирование Исследование выполнено в рамках государственного задания по теме фундаментальных научных исследований № 122123000017-3. Конфликт интересов Авторы заявляют об отсутствии конфликта интересов. Вклад авторов Концепция и дизайн работы: Н.О. Каменщиков, И.В. Кравченко, Ю.К. Подоксенов, Б.Н. Козлов Сбор и анализ данных: И.В. Кравченко, М.А. Тё, Е.А. Чурилина, М.С. Козулин, А.М. Гусакова, Т.П. Калашникова Статистическая обработка данных: И.В. Кравченко, Ю.К. Подоксенов Написание статьи: И.В. Кравченко, Ю.К. Подоксенов Исправление статьи: Н.О. Каменщиков, Б.Н. Козлов Утверждение окончательного варианта статьи: Н.О. Каменщиков, Ю.К. Подоксенов, И.В. Кравченко, Б.Н. Козлов, М.А. Тё, Т.П. Калашникова, Е.А. Чурилина, М.С. Козулин, А.М. Гусакова

The aim of the study was to evaluate the antimicrobial effect of single and repeated nitric oxide (NO) exposure on the major pathogens of nosocomial pneumonia isolated from the sputum of cardiac surgery patients.Materials and Methods. A 24-hour culture of microorganisms from pan-resistant isolates of Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae from the sputum of inpatient cardiac surgery patients with nosocomial pneumonia, as well as strains of P. aeruginosa and E. coli from the American Type Culture Collection (ATCC), were exposed to 200 ppm NO (experimental sample) or medical air (control sample) in a sealed chamber for 30 minutes. After a single or 4 repeated gas exposure at 4 h intervals, Petri dishes were placed in a thermostat at 37°C and the results were evaluated at 24 and 48 h or at 12, 24, 36 and 48 h, respectively. Grown colonies were counted using an automated colony counter and recorded as CFU/mL.Results. No growth of clinical isolates of P. aeruginosa and E. coli was observed 24 and 48 h after a single exposure to NO. Growth of A. baumannii was lower compared to controls at 24 h but continued at 48 h. No effect of a single exposure to 200 ppm NO on other microorganisms was observed. After 4 exposures to NO, the growth of ATCC E. coli was not detected, the growth of other experimental strains was significantly lower compared to the control (P<0.05).Conclusion. Our results provide a rationale for the use of multiple intermittent inhalation of 220 ppm NO for the treatment of patients with hospital-acquired bacterial pneumonia.

HighlightsFor the first time, the incidence and timing of the development of postoperative pneumonia in patients undergoing surgical reconstruction of the aortic arch in the post-covid period were studied. Risk factors for pneumonia and predictors of the severe course of the disease in this cohort of patients were identified. The results obtained will make it possible to differentiate patients at risk of developing pneumonia from the general population of patients undergoing surgical reconstruction of the aortic arch for targeted perioperative prevention of this complication. AbstractAim. To study the incidence of nosocomial pneumonia (NP) after aortic arch surgery, and to determine the impact of perioperative factors on the risk for its development and severity of its course.Methods. A retrospective analysis of 66 case histories of patients who underwent aortic arch surgery in 2022 was carried out. The incidence and timing of the development of pneumonia were revealed, the severity of its course was assessed. The impact of the main demographic, clinical, perioperative factors on the risk for the pneumonia development and the severity of its course was studied.Results. The incidence of pneumonia after aortic arch surgery was 24.2%. A relationship between smoking (OR 1.17; 95% CI [0.23; 1.43], p = 0.007), smoking index (OR 0.99; 95% CI [0.92; 1.07], p = 0.002) and the risk of NP developing as well as between the duration of mechanical ventilation and the severity of NP was found with a univariate logistic regression analysis (OR 1.26; 95% CI [1.0; 1.59], p = 0.049).Conclusion. The risk for NP development in patients who underwent thoracic aortic surgery is associated with smoking and smoking intensity in the preoperative period. The predictor of the severe course of NP is the duration of mechanical ventilation.

Objective. To assess the quality of sleep in students of higher educational institutions of Perm taking into account the profile, anxiety level and social employment. Materials and methods. The study enclosed 300 students of three higher educational institutions of Perm. The features of sleep were analyzed on the basis of questioning followed by statistical treatment of the obtained data. Results. For all the students, the prevalence of the borderline parameters with subjective assessment of the quality of sleep was a general feature. The students of medical university with a high subjective assessment of the quality of sleep had an excessive daytime sleepiness (50 % of respondents). Medical students were characterized by a night and twenty-four-hour operating schedule and a more expressed situational anxiety. For the students of humanitarian and pedagogical institutions, combination of a high level of personal anxiety with low parameters of the quality of sleep were typical. Sleep was characterized by a long falling asleep with frequent awakening during the night, plenty of dreams often anxious by their content. At the same time, most students preferred work in the daytime. This group of students had a maximum risk for the development of sleep apnea. The students of polytechnic university appeared to be less vulnerable. However, the analyzed subjective characteristics of sleep among most of them demonstrated the borderline disorders, less than 1/3 of them had optimal parameters. Conclusions. The obtained results put the question of optimizing organization of sleep and wakefulness among students of higher educational institutions, prevention of disorders of circadian rhythms and their consequences, elevation of students information awareness on reciprocal influence of sleep and wakefulness. If necessary, there should be a possibility of correction by a somnologist and/or psychotherapist.

The review is devoted to one of the current problems of pediatric neurology - reading and writing disorders in children as part of a partial developmental disorder. With the development of neuroscience, the paradigm of «brain damage» in the understanding of a number of pathological conditions was replaced by the concept of «evolutionary neurology». The dominance of the ontogenetic approach caused the appearance of a new section in ICD-11 - «Neurodevelopmental disorders». Twenty-one genes associated with the acquisition of reading and writing skills have been identified. Modern studies demonstrate the connection of neuropsychological prerequisites for reading and writing, and clinical phenotypes of dyslexia with changes in specific loci. It is assumed that there are different molecular genetic bases for dyslexia and dysgraphia depending on ethnicity, orthographic features of language, including logographic features. Pleiotropy of genes is a cause of comorbidity of reading and writing disorders with attention deficit and hyperactivity disorder, specific speech articulation disorders, and dyscalculia. A key function of many of the identified genes is their involvement in the processes of neurogenesis. Their dysfunctions cause atypical neuronal migration, ectopic formation, inadequate axonal growth, and dendrite branching at the early stage of brain development. Morphological changes can distort the correct distribution and/or integration of linguistic stimuli in critical brain areas, leading to abnormalities in phonology, semantics, spelling, and general reading comprehension. The knowledge gained can form the basis for the development of risk models for dysgraphia and dyslexia formation and be used as a diagnostic and/or screening tool, which is important for evidence-based correction, optimization of academic performance, and mitigation of psychosocial consequences.

The article describes a clinical case of inhalation therapy with high doses of nitric oxide (NO) in a comorbid patient with a severe course of COVID-19. An air stream containing NO was generated using the PLAZON device. High-dose NO inhalation therapy was administered as a life-saving option due to the lack of effect from treatment delivered in accordance with the current national clinical guidelines for the treatment of COVID-19. The safety and clinical efficacy of the technique was demonstrated.

OBJECTIVE:To study the features of functional interzonal integration and its dynamics in infants from 0 to 9 months during prospective observation, taking into account the timing gestation, clinical picture and morphological changes on neurosonography (NSG).MATERIAL AND METHODS:A comprehensive unified examination was carried out in dynamics in 89 infants three times at the age of 3, 6, 9 months and included, in addition to assessing the neurological status, the Denver Developmental Screening Test (DDST), transfontanellar ultrasonography with a vector sensor according to the generally accepted method. We also evaluated the parameters of electroencephalography (EEG) recorded in the waking state with an analysis of background parameters, zonal differences, and the identification of pathological types of activity and calculation of the average coherence power (ACP). In accordance with the gestational age, infants are divided into two groups of full-term and premature babies.RESULTS:In the group of premature babies, the clinical picture in the neonatal period was dominated by cerebral ischemia of I and II degrees. The DDST parameters throughout the entire observation period did not reveal any deviations from the optimal development in all children. There were significant changes in functional connectivity (FC) in premature infants, which were more pronounced by 9 months. Functional hyperintegration was recorded in the intrahemispheric occipital-temporal and occipital-central regions bilaterally, in the anterofrontal-temporal leads on the left and in the interhemispheric anterofrontal regions. The ACP indicators were affected by changes in the NSG. An increase in ACP values in the occipitotemporal leads was associated with the presence of subependymal cysts in both preterm and full-term infants. Intraventricular hemorrhages and increased echogenicity in the periventricular zones in preterm infants were associated with an increase in coherence in the anterior frontal, left occipito-central, and temporo-anterofrontal leads.CONCLUSION:Thus, in preterm infants with cerebral ischemia of grades I and II, as well as in children with subependymal cysts, ACP indicators indicate hyperintegration of brain areas that are of fundamental importance for speech development and the formation of cognitive functions. Changes in the level of FC in the areas of the cerebral cortex in children with low gestational age, cerebral ischemia I and II, even at the optimal rate of motor and preverbal development, require further study, as it can reflect both the physiological processes of maturation in the postnatal period with transient deviations, and act as the role of possible early markers of future variants of deviant development.

The article presents a review. Information on metabolism of vitamin D and its significance in the formation of the brain in the prenatal and postnatal periods is given. An up-to-date data regarding the effect of vitamin D on neurogenesis, activity of neurotransmitter systems, formation of cognitive status and quality of emotional state in children and adolescents is analyzed. The role of vitamin D in pathogenesis of autistic spectrum disorders, resistant forms of epilepsy, deviant variants of development in children is discussed.

This article discusses current concepts of the clinical features of sleep in children with attention deficit hyperactivity disorder (ADHD), along with sleep macrostructure, its cyclical organization, and the possible common pathways in the pathogenesis of sleep disorders and regulatory functions, and levels of social maladaptation of patients with ADHD. Typical features of children with ADHD are difficulty going to sleep and long times to onset of sleep (resistance to sleep time), increased sleep-related movement activity, including the association of ADHD with restless legs syndrome (RLS) and periodic leg movement during sleep syndrome (PLMS), and daytime sleepiness. The occurrence of circadian desynchronization in children with ADHD explains the link between the chronotype, the circadian typology, and the clinical signs of the syndrome. There are opposing data on the level of rapid eye movement (REM) sleep based on nocturnal polysomnography data in children with ADHD depending on age. However, changes in the proportion of REM sleep during the night are regarded as the leading factor in the pathogenesis of signs of ADHD. Common pathogenetic mechanisms are identified for sleep disorders and ADHD: a diversity of impairments to the metabolism of melatonin, dopamine, and serotonin, aggravation of “social jetlag,” and changes in blood iron and ferritin concentrations, which may explain the frequency of RLS and PLMS in children with ADHD. This group of patients displays changes in the number of sleep cycles during the night. Possible strategies for correcting sleep disorders in children with ADHD and their influences on the signs of ADHD are discussed.

Objective. The article analyzes the clinical features of sleep in preschoolers aged 3-7 years in the city of Perm on the basis of a continuous questionnaire method. Materials and methods. The presence of complaints related to sleep at the time of the survey was substantiated in 45 % of children of the younger age group (from 3 to 5 years) and 41 % of children in the older age group (from 5 to 7 years). Results. Sexual dimorphism manifested itself in a significant dominance of intrasomnic disturbances with frequent awakenings and increased motor activity during sleep in older boys. Nocturnal pains and / or cramps in the leg muscles prevailed in girls of the older age group. In the structure of parasomnias in Perm preschool children, there predominated nightmares (16.5 %), night fears (13.3 %), bruxism (14.8 %), sleepwalking (12.8 %), enuresis (8.2 %). Every fifth child of preschool age had sleep with an open mouth, snoring or puffing, hyperhidrosis during sleep and chronic adenotonsillar pathology, which does not exclude the presence of obstructive sleep apnea / hypopnea syndrome in this category of children. Conclusions. Sleep disorders were noted in a quarter of children under one year of age, manifested by difficult falling asleep, restless sleep and sleep inversion, which can be a marker of both disorders of maturation of chronobiological mechanisms and a high percentage of childhood behavioral insomnia.

Цель. На основании метода сплошного анкетирования проанализировать клинические особенности сна дошкольников в возрасте 3–7 лет, проживающих в г. Перми. Материалы и методы. На момент обследования обосновано наличие жалоб, связанных со сном, у 45 % детей младшей возрастной группы (от 3 до 5 лет) и 41 % детей старшей возрастной группы (от 5 до 7 лет). Результаты. Половой диморфизм проявлялся в достоверном доминировании интрасомнических нарушений с частыми пробуждениями и повышенной двигательной активностью во сне у мальчиков старшей возрастной группы. Ночные боли и/или судороги в мышцах ног превалировали у девочек старшей возрастной группы. В структуре парасомний у детей дошкольного возраста преобладали ночные кошмары (16,5 %), ночные страхи (13,3 %), бруксизм (14,8 %), сноговорение (12,8 %), энурез (8,2 %). У каждого пятого ребенка дошкольного возраста определялись сон с открытым ртом, храп или сопение, потливость во время сна и хроническая аденотонзиллярная патология, что не исключает наличия синдрома обструктивных апноэ/гипопноэ сна у этой категории детей. Выводы. Расстройства сна отмечались у четверти детей до года, проявляющиеся трудностью засыпания, беспокойным сном, инверсией сна, что может быть маркером как нарушения созревания хронобиологических механизмов, так и детской поведенческой инсомнии.

A complex examination revealed the features of the development of higher cortical functions and sleep clinical features in preschool children with obstructive sleep apnea. Typical features were identified in the macrostructure of sleep and its cyclic organization in the children. Connective tissue dysplasia proved to act as a significant etiological factor in the pathogenesis of obstructive sleep apnea–hypopnea syndrome (OSAHS) in children. The effect of OSAHS on the cognitive development of children was investigated. Ontogenetic features were identified in the formation of OSAHS in preschool children. Signs of multicomponent and multilevel dysontogenetic syndrome were observed, including distorted maturation of basic higher cortical functions and alterations of the macrostructure and cyclic organization of sleep.

Behavioral insomnia is the most common sleep disorder in young children. It significantly reduces the quality of parent's life and is one of the common complaints to a pediatrician or neurologist. The basis treatment of childhood insomnia is behavioral therapy, which includes sleep hygiene, age-appropriate daily routine and sleep associations, stable bedtime routines, positive reinforcement, bedtime fading, scheduled awakenings. Although a systematic ignoring («crying it out») is effective and widely used in behavioral therapy, it has low compliance and its safety is insufficiently studied. Therefore, a systematic ignoring is not a priority method of behavioral therapy and should not be used in children under 6 months of age. Behavioral therapy of childhood insomnia is complemented by psychological and informational support from parents, and in some cases, drug therapy. Prevention includes education of expectant parents on baby sleep hygiene.

AIM:To study the association between psychological gender and adherence to immunomodulatory therapy in patients with multiple sclerosis. MATERIAL AND METHODS:Thirty-four patients (25 women and 9 men) with the diagnosis of multiple sclerosis were examined. The following methods were used: MMSE, The Bem Sex Role Inventory adapted in Russia, Beck Depression Inventory, State-Trait Anxiety Inventory. During three months patients reported the first and the last immunomodulator injections dates from every new pack. Then the patients' self-reports systematization and analysis were performed, drug-taking compliance and timing compliance were calculated. RESULTS AND CONCLUSION:Twenty-eight patients had an androgynous type of psychological gender and six persons were feminine. The association was determined between high compliance and such psychological gender peculiarities as a significantly large number of feminine traits than masculine ones and the low number of masculine characteristics in men.

The article presents the modern view of etiology of the obstructive sleep apnoea/hypopnoea syndrome (OAHSS) in the children taking into consideration the ontogenetic stage and the principal mechanisms of its formation including the short-term and long-term consequences of sleep apnoea with special reference to the pathogenetic commonness of OAHSS with endothelial dysfunction, metabolic syndrome, cardiac disorders, and systemic chronic inflammation. The role of ENT diseases in the children with obstructive sleep apnoea is discussed. The results of genetic studies of the processes influencing the formation of the risk of development of sleep apnoea/hypopnoea syndrome and its outcomes in the children are discussed.

AIM:To study and compare clinical characteristics of sleep macrostructure and sleep cycle organization during the night polysomnographic study in children with attention deficit hyperactivity disorder (ADHD) and obstructive sleep apnea syndrome (OSAS) aged from 6 to 9 years.MATERIAL AND METHODS:Polysomnography was performed in 40 children with ADHD and 20 children with OSAS. The control group included 20 healthy children.RESULTS AND CONCLUSION:The changes in sleep architectonics were unidirectional. Typical for the two groups of children was an increase in the latency of REM sleep and a reduction of its duration in total time of sleep. In children with ADHD, there was a significant decrease in the total number of sleep cycles, with a significant increase in the duration of the first sleep cycle. For an objective assessment of the rhythmic organization of ultradian rhythms, the authors propose a formula to calculate the maturity index of sleep in children older than 6 years. From the standpoint of evolutionary neuroscience, results should be considered as manifestations of dysontogenesis.

Aim. To study the clinical peculiar features of sleep and its structure by the data of night polysomnographic study and peculiarities of development of higher cortical functions (HCF) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS). Materials and methods. Clinical, neuropsychological and polysomnographic examination of 25 preschool-age children with OSAHS was carried out. The group of сomparison included 10 healthy children. Clinical study of sleep was assessed, using specially developed by the author sleep questionnaire; HCF status was estimated by means of neuropsychological study, adapted for child age (E.G. Simernitskaya). Results. Some peculiar features of organizing sleep in children with obstructive night apnea were detected. There was demonstrated a reduced duration of drowsiness, decreased duration of fast sleep phase, reduced number of sleep cycles and vegetative disorders in the form more frequent episodes of tachycardia, confirming sympathicotonia during night sleep. Kinesthetic dyspraxia was registered in 76 % of observations among apnea children. Differences in anxiety level were registered in extreme values of anxiety index (AI); AI > 50 %, considered as high, was revealed in 72 % of patients with OSAHS. High productivity and stability of attention ( S = 1.00-1.25) was noted in 35 % of control children, in OSAHS group this index was 4 %. Conclusions. Reduced duration of fast sleep phase in children with apnea is a matter of principle. Not only snore is a marker of OSAHS, apnea can occur without marked concomitant snoring. The role of connective tissue dysplasia in OSAHS formation is to be discussed. Muscular hypotonia formed can increase constriction of the upper airways, especially within the fast sleep phase and provoke apnea/hypopnea episodes.