Renin-angiotensin-aldosterone system in patients with sleep apnoea: prevalence of primary aldosteronism
Open accessAbstract
Obstructive sleep apnoea (OSA) is a sleep disorder characterized by recurrent episodes of oxygen desaturation during sleep, representing an independent risk factor for cardiovascular disease, such as myocardial infarction, stroke, congestive heart failure and resistant hypertension. Several neurohormonal mechanisms have been suggested to account for blood pressure increases, such as sympathetic nervous system hyperactivity, oxidative stress, renin—angiotensin—aldosterone system (RAAS) activation, endothelin system activation, and endothelial dysfunction. The aim of this study was to evaluate the behaviour of RAAS and the presence of primary aldosteronism (PA) in these patients and possible correlations between RAAS and the severity of OSA. From October 2007 to November 2008 we studied 325 consecutive newly diagnosed hypertensive patients; 71 patients (21.8%) presented with clinical signs of sleep disorders, evaluated also through a specific questionnaire (Epworth Sleepiness Scale). In hypertensive patients with sleep disorders, 53 patients were affected by OSA; in this group 18 patients were affected by PA (five with aldosterone-producing adenoma (APA) and 13 with bilateral hyperplasia (IHA)); obesity was also demonstrated (BMI >" xbd="961" xhg="938" ybd="2430" yhg="2403"/> 30 kg/m 2 ). Overall, in patients with OSA PRA levels correlated positively with apnoea/hypopnoea index (AHI; r = 0.35; p<0.01), and in all groups the waist circumference and the neck circumference were correlated positively with AHI ( r = 0.3 p<0.02 and r = 0.3 p<0.03, respectively). We revealed a high prevalence of PA in patients with OSA, and we can conclude that patients with hypertension and OSA, especially those who are newly diagnosed, must be evaluated for PA.
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The high occurrence of obstructive sleep apnea in patients with resistant hypertension has been attributed to increased fluid retention and accompanying upper airway edema, as suggested by studies positively relating the presence and severity of obstructive sleep apnea to aldosterone excess and high dietary sodium intake.
“The high occurrence of OSA in patients with RH has been attributed to increased fluid retention and accompanying upper airway edema, as suggested by studies positively relating the presence and severity of OSA to aldosterone excess and high dietary sodium intake.47,49,277–279”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [278]
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- Authors
- Di Murro, A., Petramala, L., Cotesta, D., Zinnamosca, L., Crescenzi, E., Marinelli, C., Saponara, M., & Letizia, C.
- Affiliations
- Department of Clinical Sciences, Day Service Secondary of Hypertension, Policlinico Umberto I, Rome, Italy
- Policlinico Umberto I (IT)
- Sapienza University of Rome (IT)
- Venue
- Journal of the Renin-Angiotensin-Aldosterone System
- Publisher
- SAGE Publications
- Published
- 2010-05-20
- Volume
- 11
- Issue
- 3
- Pages
- 165-172
- ISSN
- 1470-3203 (ISSN-L)
- 1752-8976
- OpenAlex
- W2126557895
- Cited by
- 125
- References
- 45
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 12 · 2023: 11 · 2022: 11 · 2021: 6 · 2020: 9 · 2019: 11 · 2018: 7 · 2017: 6 · 2016: 10 · 2015: 8 · 2014: 4 · 2013: 5 · 2012: 7
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- Locations
- Journal of the Renin-Angiotensin-Aldosterone System (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Keywords
- obstructive sleep apnea, primary aldosteronism, renin-angiotensin-aldosterone system, aldosterone-producing adenoma, bilateral adrenal hyperplasia, hypertension, apnea-hypopnea index, obesity, waist circumference, neck circumference, resistant hypertension, prevalence
- MeSH terms
- Adult, Aldosterone, Female, Humans, Hyperaldosteronism, Italy, Male, Middle Aged, Obesity, Renin, Renin-Angiotensin System, Prevalence, Sleep Apnea, Obstructive
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