Severity of obstructive sleep apnea is related to aldosterone status in subjects with resistant hypertension.
BACKGROUND
We previously described a significant correlation between plasma aldosterone concentration (PAC) and severity of obstructive sleep apnea (OSA) in patients with resistant hypertension. This investigation examines the relationship between aldosterone status and OSA in patients with resistant hypertensive-with and without hyperaldosteronism.


RESULTS
One hundred and nine consecutive patients with resistant hypertension were prospectively evaluated with plasma renin activity (PRA), PAC, 24-hour urinary aldosterone excretion (UAldo), and polysomnography. Hyperaldosteronism (PRA < 1 ng x mL(-1) x h(-1) and UAldo > or = 12 microg/24-h) prevalence was 28% and OSA prevalence was 77%. In patients with hyperaldosteronism, OSA prevalence was 84%, compared with 74% in hypertensive patients with normal aldosterone levels. There were no significant differences in body mass index or neck circumference between aldosterone groups. PAC and UAldo were both significantly correlated with apnea-hypopnea index (AHI) in the high-aldosterone group (p = 0.568, p = 0.0009; p = 0.533, p = 0.002, respectively). UAldo correlated weakly with apnea-hypopnea index in the normal-aldosterone group, but there was no significant correlation between PAC and AHI in the normal-aldosterone group (p = 0.224, p = 0.049; p = 0.015, p = 0.898, respectively).


CONCLUSIONS
Our analysis of patients with resistant hypertension confirms a markedly high prevalence of OSA in this group. Furthermore, severity of OSA was greater in those patients with hyperaldosteronism and related to the degree of aldosterone excess. The correlation between OSA severity and aldosterone supports the hypothesis that aldosterone excess contributes to greater severity of OSA.
Gonzaga
Carolina C
CC
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, AL, USA. carolinadcg@hotmail.com
Gaddam
Krishna K
KK
Ahmed
Mustafa I
MI
Pimenta
Eduardo
E
Thomas
S Justin
SJ
Harding
Susan M
SM
Oparil
Suzanne
S
Cofield
Stacey S
SS
Calhoun
David A
DA
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000652:urine*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology / Q000652:urine*; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D012016:Reference Values; D012083:Renin / Q000097:blood; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000652:urine*
D000450:Aldosterone; D012083:Renin