title: Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoea.
abstract: Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment of PA improves sleep apnoea parameters in these patients. We therefore aimed to determine whether specific medical or surgical treatment of PA improves OSA, as measured by the apnoea-hypopnoea index (AHI). We recruited patients undergoing diagnostic workup for PA if they had symptoms suggestive of OSA. Patients with confirmed PA underwent polysomnography (PSG) at baseline and again at least 3 months after specific treatment for PA. Of 34 patients with PA, 7 (21%) had no evidence of OSA (AHI <5), 9 (26%) had mild (AHI ⩾5 and <15), 8 (24%) moderate (AHI ⩾15 and <30) and 10 (29%) severe OSA (AHI ⩾30). Body mass index tertile, neck circumference and 24 h urinary sodium correlated with the AHI. Twenty patients had repeat PSG performed after treatment for PA (mineralocorticoid receptor antagonists in 13 with bilateral PA and adrenalectomy in 7 with unilateral PA). In this group the median (s.d.) AHI reduced from 22.5 (14.7) to 12.3 (12.1) (P=0.02). Neck circumference reduced with PA treatment (41.6 vs 41.2 cm, P=0.012). OSA is common in patients with primary aldosteronism and may improve with specific therapy for this disease. Aldosterone and sodium-mediated fluid retention in the upper airways and neck region may be a potential mechanism for this relationship.
authors.affiliation: Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wolley
authors.affiliation: Experimental Medicine CV/Hem, Clinical Sciences, Global Drug Discovery, Bayer Pharma AG, Wuppertal, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Pimenta
authors.affiliation: Sleep/Wake Disorders Center, Division of Pulmonary, Allergy and Critical Care Medicine and Vascular Biology and Hypertension Program, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: D
authors.initials: D
authors.lastname: Calhoun
authors.affiliation: Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia.
authors.forename: R D
authors.initials: RD
authors.lastname: Gordon
authors.affiliation: Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Cowley
authors.affiliation: Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Greenslopes and Princess Alexandra Hospitals, Brisbane, Queensland, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Stowasser
mesh_terms: D000315:Adrenalectomy; D000328:Adult; D015415:Biomarkers / Q000652:urine; D005260:Female; D018495:Fluid Shifts; D006801:Humans; D006929:Hyperaldosteronism / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009333:Neck; D017286:Polysomnography; D011446:Prospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012964:Sodium / Q000652:urine; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
chemical_list: D015415:Biomarkers; D000451:Mineralocorticoid Receptor Antagonists; D012964:Sodium