BACKGROUND: Resistant hypertension is common in patients with primary aldosteronism and in those with obstructive sleep apnea. Primary aldosteronism treatment improves sleep apnea. Despite Endocrine Society guidelines' inclusion of sleep apnea and hypertension co-diagnosis as a primary aldosteronism screening indication, the state of screening implementation is unknown. METHODS: All hypertensive adult patients with obstructive sleep apnea (n = 4751) at one institution between 2012 and 2020 were compared with a control cohort without sleep apnea (n = 117,815). We compared the association of primary aldosteronism diagnoses, risk factors, and screening between both groups. Patients were considered to have screening if they had a primary aldosteronism diagnosis or serum aldosterone or plasma renin activity evaluation. RESULTS: Obstructive sleep apnea patients were predominantly men and had higher body mass index. On multivariable analysis, hypertensive sleep apnea patients had higher odds of drug-resistant hypertension (odds ratio [OR] 2.70; P < .001) and hypokalemia (OR 1.26; P < .001) independent of body mass index, sex, and number of antihypertensive medications. Overall, sleep apnea patients were more likely to be screened for primary aldosteronism (OR 1.45; P < .001); however, few patients underwent screening whether they had sleep apnea or not (pre-guideline publication 7.8% vs 4.6%; post-guidelines 3.6% vs 4.6%; P < .01). Screening among eligible sleep apnea patients remained low prior to and after guideline publication (4.4% vs 3.4%). CONCLUSIONS: Obstructive sleep apnea is associated with primary aldosteronism risk factors without formal diagnosis, suggesting screening underutilization and underdiagnosis. Strategies are needed to increase screening adherence, as patients may benefit from treatment of concomitant primary aldosteronism to reduce sleep apnea severity and its associated cardiopulmonary morbidity.
BACKGROUND: Resistant hypertension is common in patients with primary aldosteronism and in those with obstructive sleep apnea. Primary aldosteronism treatment improves sleep apnea. Despite Endocrine Society guidelines' inclusion of sleep apnea and hypertension co-diagnosis as a primary aldosteronism screening indication, the state of screening implementation is unknown. METHODS: All hypertensive adult patients with obstructive sleep apnea (n = 4751) at one institution between 2012 and 2020 were compared with a control cohort without sleep apnea (n = 117,815). We compared the association of primary aldosteronism diagnoses, risk factors, and screening between both groups. Patients were considered to have screening if they had a primary aldosteronism diagnosis or serum aldosterone or plasma renin activity evaluation. RESULTS: Obstructive sleep apnea patients were predominantly men and had higher body mass index. On multivariable analysis, hypertensive sleep apnea patients had higher odds of drug-resistant hypertension (odds ratio [OR] 2.70; P < .001) and hypokalemia (OR 1.26; P < .001) independent of body mass index, sex, and number of antihypertensive medications. Overall, sleep apnea patients were more likely to be screened for primary aldosteronism (OR 1.45; P < .001); however, few patients underwent screening whether they had sleep apnea or not (pre-guideline publication 7.8% vs 4.6%; post-guidelines 3.6% vs 4.6%; P < .01). Screening among eligible sleep apnea patients remained low prior to and after guideline publication (4.4% vs 3.4%). CONCLUSIONS: Obstructive sleep apnea is associated with primary aldosteronism risk factors without formal diagnosis, suggesting screening underutilization and underdiagnosis. Strategies are needed to increase screening adherence, as patients may benefit from treatment of concomitant primary aldosteronism to reduce sleep apnea severity and its associated cardiopulmonary morbidity.
Authors: John J Sim; Eric H Yan; In Lu A Liu; Scott A Rasgon; Kamyar Kalantar-Zadeh; David A Calhoun; Stephen F Derose Journal: J Hypertens Date: 2011-08 Impact factor: 4.844
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Authors: Monique N Pratt-Ubunama; Mari K Nishizaka; Robyn L Boedefeld; Stacey S Cofield; Susan M Harding; David A Calhoun Journal: Chest Date: 2007-02 Impact factor: 9.410
Authors: R Doug McEvoy; Nick A Antic; Emma Heeley; Yuanming Luo; Qiong Ou; Xilong Zhang; Olga Mediano; Rui Chen; Luciano F Drager; Zhihong Liu; Guofang Chen; Baoliang Du; Nigel McArdle; Sutapa Mukherjee; Manjari Tripathi; Laurent Billot; Qiang Li; Geraldo Lorenzi-Filho; Ferran Barbe; Susan Redline; Jiguang Wang; Hisatomi Arima; Bruce Neal; David P White; Ron R Grunstein; Nanshan Zhong; Craig S Anderson Journal: N Engl J Med Date: 2016-08-28 Impact factor: 91.245
Authors: Elizabeth A Alore; James W Suliburk; David J Ramsey; Nader N Massarweh; Courtney J Balentine; Hardeep Singh; Samir S Awad; Konstantinos I Makris Journal: JAMA Intern Med Date: 2019-09-01 Impact factor: 21.873