Li Mingyan, Ge Qian, Sheng Chang-Sheng, Zhang Jin, Li Hua, Niu Wenquan, Tang Xiaofeng, Xu Jianzhong, Gao Ping-Jin, Wang Ji-Guang, Zhu Limin
Department of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
International Medical Center of Henan Province, Henan Provincial People's Hospital, Henan, China.
J Hum Hypertens. 2019 Sep;33(9):693-700. doi: 10.1038/s41371-019-0208-9. Epub 2019 May 14.
The 2016 guideline on the work-up of primary aldosteronism recommended that patients with obstructive sleep apnea-hypopnea syndrome (OSAS) be screened. This study aimed to identify the clinical characteristics of snoring patients with primary aldosteronism (PA) complicated by OSAS. Sixty-eight self-reported or witnessed snoring patients and 609 non-snoring patients diagnosed with PA between 2010 and 2015 were recruited in this retrospective study. Compared to non-snoring patients, snoring patients had significantly (P < 0.05) higher body mass index (BMI), diastolic blood pressure (DBP), and serum and urinary sodium, as well as lower estimated glomerular filtration rate (eGFR). Moreover, snoring patients exhibited significantly (P < 0.01) higher plasma renin activity levels and lower plasma aldosterone levels and aldosterone-to-renin activity ratios (ARRs) than patients with PA alone. When age, sex, duration of hypertension, and BMI were matched between groups, snoring patients still showed significantly (P < 0.05) higher plasma renin activity, serum and urinary sodium, and lower ARR and eGFR than those in the PA-only group. All 68 snoring patients underwent polysomnography, with 7 having mild (apnea-hypopnea index (AHI) ≥ 5 and <15), 21 moderate (AHI ≥ 15 and <30), and 40 severe (AHI ≥ 30) OSAS. The BMI of patients with OSAS was negatively correlated with the lowest SaO (r = -0.318, P = 0.018) but not with the AHI. In conclusion, snoring patients with PA tend to have increased BMI and DBP, as well as decreased eGFR and ARR. Snoring patients with PA had higher prevalence of moderate-to-severe OSAS.
2016年原发性醛固酮增多症诊治指南建议对阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者进行筛查。本研究旨在明确原发性醛固酮增多症（PA）合并OSAS的打鼾患者的临床特征。本项回顾性研究纳入了2010年至2015年间68例自述或被目击有打鼾症状的患者以及609例确诊为PA的非打鼾患者。与非打鼾患者相比，打鼾患者的体重指数（BMI）、舒张压（DBP）、血清及尿钠水平显著更高（P<0.05），而估算肾小球滤过率（eGFR）更低。此外，与单纯PA患者相比，打鼾患者的血浆肾素活性水平显著更高（P<0.01），血浆醛固酮水平及醛固酮/肾素活性比值（ARR）更低。当两组在年龄、性别、高血压病程及BMI方面匹配后，打鼾患者的血浆肾素活性、血清及尿钠水平仍显著高于单纯PA组（P<0.05），而ARR及eGFR更低。68例打鼾患者均接受了多导睡眠监测，其中7例为轻度OSAS（呼吸暂停低通气指数（AHI）≥5且<15），21例为中度（AHI≥15且<30），40例为重度（AHI≥30）。OSAS患者的BMI与最低血氧饱和度（SaO）呈负相关（r=-0.318，P=0.018），但与AHI无关。总之，PA合并打鼾的患者往往BMI及DBP升高，而eGFR及ARR降低。PA合并打鼾的患者中重度OSAS的患病率更高。
