Screening for Primary Aldosteronism is Underutilized in Patients with Obstructive Sleep Apnea
Autor: | Julie Ann Sosa, Kathryn Chomsky-Higgins Menut, Patricia C. Conroy, Sarah S Pearlstein, Quan-Yang Duh, Sanziana A. Roman, Insoo Suh, Chienying Liu, Jessica E. Gosnell, Wen T. Shen, Sophia Hernandez, Claire E. Graves |
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Rok vydání: | 2022 |
Předmět: |
Male
medicine.medical_specialty Sleep Apnea Cardiovascular Plasma renin activity Medical and Health Sciences Article Primary aldosteronism Risk Factors Clinical Research Internal medicine General & Internal Medicine Hyperaldosteronism Medicine Humans Lung Retrospective Studies Aged Sleep Apnea Obstructive business.industry Obstructive Sleep apnea General Medicine Odds ratio Middle Aged Health Services medicine.disease Obstructive sleep apnea United States Concomitant Cohort Screening Female business Sleep Research Body mass index |
Zdroj: | The American journal of medicine, vol 135, iss 1 Am J Med |
Popis: | BackgroundResistant 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.MethodsAll 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.ResultsObstructive 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%).ConclusionsObstructive 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. |
Databáze: | OpenAIRE |
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