Sleep quality in patients with primary aldosteronism

Abstract

ObJEctIVE: In subjects at high risk for sleep apnea (sA), aldosterone concentrations correlate with severity of sA and primary aldosteronism (PA) is very often diagnosed. Patients with PA show a high prevalence of sA. treatment of PA either by adrenalectomy (ADX) or mineralocorticoid receptor (Mr) blockade is thought to abolish the increased comorbidities. However, no data are available regarding effectiveness of different PA treatments on quality of sleep. DEsIGN: this prospective multi-center study included 15 patients with newly diagnosed PA evaluated before and 0.7±0.2 years after treatment initiation, and a second cohort including 81 patients who were evaluated 5.3 and 6.8 years after treatment initiation. biochemical parameters, 24h blood pressure and three validated self-assessment questionnaires (Giessen complaint List (Gbb-24), Epworth sleepiness scale (Ess) and Pittsburgh sleep Quality-Index (PsQI)) were analyzed. rEsULts: Z-scores of exhaustion tendency of Gbb significantly improved in newly diagnosed PA patients after treatment initiation (1. 8±1.4 vs. 1.0±1.2, p=0.034). In the second cohort no differences were found in Gbb-24, Ess and PsQI. No differences were found in all three questionnaires independently of type of PA therapy. However, female patients scored significantly higher than males in the PsQI (8.7±3.6 vs 5.7±4.2, p<0.005), indicating lower sleep quality, independently of the type of therapy. cONcLUsIONs: For the first time, we analyzed quality of sleep in patients with PA, demonstrating that therapy initiation improves exhaustion tendency. surprisingly, female PA patients showed significantly more sleep disturbances than male PA patients several years after treatment initiation.

Systematic review of surgery and outcomes in patients with primary aldosteronism

“…Data on surgical versus medical treatment of PA are summarized in Table . In six studies, five prospective and one retrospective, the effects on improvement of BP and hypokalaemia were similar in surgically and medically treated patients. In another six studies, four prospective and two retrospective, the effects on BP and hypokalaemia were better in surgically treated patients, or they needed fewer antihypertensive drugs.…”

“…Of these, 25 were excluded owing to lack of relevant data (16 articles), outcomes not reported uniformly or not separated for treatment modality (7), or overlapping publications (2). Forty‐three publications were included in the qualitative analysis; 21 addressed adrenalectomy versus medical treatment for PA, four total versus partial adrenalectomy for lateralized PA, and 18 reported outcomes after surgery for PA in patient series comprising 70 or more patients. Owing to wide variations in definitions of biochemical diagnosis of PA, heterogeneity in investigations and treatment protocols, and lack of standardized reporting of outcomes, data could not be extracted for a quantitative meta‐analysis.…”