Severity of Obstructive Sleep Apnea is Related to Aldosterone Status in Subjects with Resistant Hypertension

Abstract

Current Knowledge/Study Rationale: We previously described a significant correlation between plasma aldosterone concentration and severity of obstructive sleep apnea in patients with resistant hypertension. This investigation examines the relationship between aldosterone status and obstructive sleep apnea in patients with resistant hypertensive-with and without hyperaldosteronism. Study Impact: The positive relationship between hyperaldosteronism and severity of obstructive sleep apnea (OSA) observed in the current analysis supports the hypothesis that aldosterone excess contributes to the development of OSA. The results highlight the increased likelihood of hyperaldosteronism and OSA coexisting in patients with resistant hypertension and may explain, at least in part, the high prevalence of OSA in patients with resistant hypertension.

Effect of Antihypertensive Medications on the Severity of Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

“…In patients with resistant hypertension, growing evidence suggests that aldosterone excess contributes to greater severity of OSA by promoting fluid retention, and subsequently parapharyngeal edema. 19,46 Patients with resistant hypertension have been shown to have higher aldosterone levels and intravascular volume expansion, as compared to controls. 47 Thus, treatment with aldosterone blockers, such as spironolactone, may improve OSA severity.…”

Sleep quality in patients with primary aldosteronism

“…A previous study showed that treatment with MR antagonists results in an improvement of symptoms of sleep apnea, indicating a possible correlation between OSA and fluid retention which leads to oro-pharyngeal edema and hence to sleep apnea. 1 This might be also a pathophysiological process in patients with PA. In addition, poor sleep quality, expressed as higher PSQI scores, was observed in non-dippers with newly diagnosed stage 1 hypertension compared to dippers, 38 suggesting that loss of blood pressure decline during the night might be involved.…”

“…6,7 Interestingly, high aldosterone levels are a common finding among patients with sleep disorders. 1,8,9 Several studies 3,10 point to OSA as a trigger of the sympathetic activity via hypoxia-induced chemoreceptor stimulation and aldosterone/sodium retention followed by an increased edema of nasopharyngeal tissue and oxidative stress as well as endothelial dysfunction. Mineralocorticoid receptor (MR) blockade seems to be effective for the treatment of OSA, 5,11 this supporting the hypothesis of MR involvement and endothelial dysfunction.…”

“…13,14 Primary aldosteronism (PA) is the most common form of secondary hypertension and affects up to 10% of all hypertensive patients, [15][16][17][18][19] and even up to 28% in patients with resistant hypertension. 1,3,10,20 Patients with PA have an increased risk of developing relevant comortalities and comorbidities, e.g. vascular, cardiac or cerebrovascular morbidities and renal insufficiency.…”

Síndrome da Apneia Obstrutiva do Sono e Doenças Cardiovasculares

“…A SAOS tem sido reconhecida ainda como a principal causa secundária de hipertensão arterial resistente pelas diretrizes europeias e americanas e pela VI Diretriz Brasileira de Hipertensão Arterial 24 . Estudos investigam o papel do hiperaldosteronismo como importante ponte dessa relação, principalmente na SAOS grave, com resultados promissores do uso de antagonista da aldosterona nessa população 25,26 .…”