Increased Dietary Sodium Is Related to Severity of Obstructive Sleep Apnea in Patients With Resistant Hypertension and Hyperaldosteronism
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Background Obstructive sleep apnea (OSA) is a strong and independent risk factor for the development of hypertension, particularly resistant hypertension, and cardiovascular diseases. Patients with resistant hypertension have a high prevalence of OSA in association with elevated aldosterone levels, high salt intake, and salt-sensitive BP. The objective of this study was to determine whether dietary salt and aldosterone are associated with severity of OSA in patients with resistant hypertension.Methods Ninety-seven patients with resistant hypertension were prospectively evaluated by overnight polysomnography and 24-h urinary sodium and aldosterone levels while maintaining their usual diet. Hyperaldosteronism was defined as a plasma renin activity of < 1 ng/mL/h and urinary aldosterone level of ≥ 12 μg/24 h.Results Overall, patients' mean clinic BP was 156.3 ± 22.4/88.9 ± 13.3 mm Hg while taking an average of 4.3 ± 1.1 antihypertensive medications. Prevalence of OSA was 77.3%. Twenty-eight (28.9%) patients had hyperaldosteronism. Urinary sodium level was an independent predictor of severity of OSA only in patients with hyperaldosteronism.Conclusions The findings suggest that dietary salt is related to the severity of OSA in patients with resistant hypertension and hyperaldosteronism. The results support dietary salt restriction as a treatment strategy for reduction of OSA severity in these patients.
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Very high proportions (60%-84%) of individuals with resistant hypertension have sleep apnea.
“Very high proportions (60%−84%) of individuals with RH have sleep apnea.33,47–49”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [49]
The severity of sleep apnea in those with resistant hypertension is positively related to dietary sodium intake, at least in those with hyperaldosteronism.
“Moreover, the severity of sleep apnea in those with RH is positively related to dietary sodium intake, at least in those with hyperaldosteronism.49”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [49]
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 [49]
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- Authors
- Pimenta, E., Stowasser, M., Gordon, R. D., Harding, S. M., Batlouni, M., Zhang, B., Oparil, S., & Calhoun, D. A.
- Affiliations
- The University of Queensland (AU)
- Instituto Dante Pazzanese de Cardiologia (BR)
- Cincinnati Children's Hospital Medical Center (US)
- University of Alabama at Birmingham (US)
- Corresponding author
- Calhoun, David A.
- Venue
- Chest
- Publisher
- Elsevier BV
- Published
- 2013-04
- Volume
- 143
- Issue
- 4
- Pages
- 978-983
- ISSN
- 0012-3692 (ISSN-L)
- PMC
- PMC3616687
- OpenAlex
- W1968354848
- Cited by
- 69
- References
- 44
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 9 · 2022: 6 · 2021: 3 · 2020: 4 · 2019: 4 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 3 · 2014: 10 · 2013: 9
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- CHEST Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5ul1rr025777-04)
- National Heart, Lung, and Blood Institute (HL-075614, R01HL075614, P50HL077100)
- National Center for Research Resources (UL1-RR-025777, 5UL1 RR025777-04)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- obstructive sleep apnea, resistant hypertension, hyperaldosteronism, dietary sodium, salt intake, urinary aldosterone, urinary sodium, OSA severity, salt-sensitive hypertension, dietary salt restriction, plasma renin activity
- MeSH terms
- Aldosterone, Blood Pressure, Cross-Sectional Studies, Female, Humans, Hyperaldosteronism, Hypertension, Male, Middle Aged, Prospective Studies, Severity of Illness Index, Sodium, Sodium, Dietary, Comorbidity, Prevalence, Polysomnography, Sleep Apnea, Obstructive
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