This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Pratt-Ubunama, M. N. Articles by Calhoun, D. A. Search for Related Content PubMed PubMed Citation Articles by Pratt-Ubunama, M. N. Articles by Calhoun, D. A.

Plasma Aldosterone Is Related to Severity of Obstructive Sleep Apnea in Subjects With Resistant Hypertension^*

^* From the Vascular Biology and Hypertension Program, Division of Cardiovascular Disease (Drs. Pratt-Ubunama, Nishizaka, and Calhoun), Division of Pulmonary, Allergy and Critical Care Medicine and Sleep/Wake Disorders Center (Drs. Boedefeld and Harding), and Department of Biostatistics (Dr. Cofield), University of Alabama at Birmingham, Birmingham, AL.

Correspondence to: David A. Calhoun, MD, 933 Nineteenth St S, Room 115, Birmingham, AL 35294; email: dcalhoun{at}uab.edu

Abstract

Objective: Obstructive sleep apnea (OSA) and primary aldosteronism are common in subjects with resistant hypertension; it is unknown, however, if the two disorders are causally related. This study relates plasma aldosterone and renin levels to OSA severity in subjects with resistant hypertension, and in those with equally severe OSA but without resistant hypertension serving as control subjects.

Methods: Seventy-one consecutive subjects referred to the University of Alabama at Birmingham (UAB) for resistant hypertension (BP uncontrolled on three medications) and 29 control subjects referred to UAB Sleep Disorders Center for suspected OSA were prospectively evaluated by an early morning plasma aldosterone concentration (PAC) and renin level, and by overnight, attended polysomnography.

Results: OSA (apnea-hypopnea index [AHI] 5/h) was present in 85% of subjects with resistant hypertension. In these subjects, PAC correlated with AHI ( = 0.44, p = 0.0002) but not renin concentration. Median PAC was significantly lower in control subjects compared to subjects with resistant hypertension (5.5 ng/dL vs 11.0 ng/dL, p < 0.05) and not related to AHI. In male subjects compared to female subjects with resistant hypertension, OSA was more common (90% vs 77%) and more severe (median AHI, 20.8/h vs 10.8/h; p = 0.01), and median PAC was significantly higher (12.0 ng/dL vs 8.8 ng/dL, p = 0.006).

Conclusion: OSA is extremely common in subjects with resistant hypertension. A significant correlation between PAC and OSA severity is observed in subjects with resistant hypertension but not in control subjects. While cause and effect cannot be inferred, the data suggest that aldosterone excess may contribute to OSA severity.

Key Words: aldosterone • obstructive sleep apnea • resistant hypertension

This article has been cited by other articles:

				S. C. Goncalves, D. Martinez, M. Gus, E. O. de Abreu-Silva, C. Bertoluci, I. Dutra, T. Branchi, L. B. Moreira, S. C. Fuchs, A. C. T. de Oliveira, et al. Obstructive Sleep Apnea and Resistant Hypertension: A Case-Control Study Chest, December 1, 2007; 132(6): 1858 - 1862. [Abstract] [Full Text] [PDF]