PRIMARY ALDOSTERONISM AND OBSTRUCTIVE SLEEP APNEA: A VICIOUS CICLE WORTH BEING ACKNOWLEDGED

Objective: Primary Aldosteronism (PA) and Obstructive Sleep Apnea(OSA) are the most frequent causes of Secondary Hypertension, and they are strictly related. Design and method: We enrolled 39 consecutive patients with confirmed PA coming for AVS. We performed a Home Sleep Apnea Test (HSAT), with clinical and biochemical measurements. We excluded patients treated for OSA. Results: Among our patients, 22 had negative HSAT (7 M,15F, median age 49, IQR 41.25-55.75, median AHI 2.15, IQR 0.725-4.425), and 17 positive HSAT (11 M,6F, median age 54, IQR 48-61, median AHI 10.55, IQR 6.65-15.625). Patients with OSA had a median throat circumference of 37.5 cm, IQR 36.75-41, a median height of 172 cm, IQR 166.75-180, a median weight of 89.5 Kg, IQR 82.25-97.25, and a median BMI of 28.12 kg/m^2, IQR 25.12-33.475. Patients without OSA had a median throat circumference of 36.5 cm, IQR 33.75-39.75, a median height of 172 cm, IQR 167.75-176.5, a median weight of 76 Kg, IQR 65-94, and a median BMI of 27.5 kg/m^2, IQR 22.875-31.01. The patients underwent an Arterial Stiffness evaluation. Group with OSA had a median Pulse Wave Velocity of 8.6 m/s, IQR 7.625-11.55; a median Augmentation index of 44.8%, IQR 27.05-52. Patients without OSA had a median Pulse Wave Velocity of 9 m/s, IQR 7.3-10.8; a median Augmentation index of 46.3%, IQR 39.2-54.2. We performed Bioimpedance analysis. Patients with OSA showed: body water 44.2 L, IQR 40.6-48.75; lean mass 60.4 Kg, IQR 55.4-66.55 and bodyfat(%) of 27.4%, IQR 23.7-37.6. In patients without OSA: body water 38.3 L, IQR 35.625-49.675; lean mass 52.3 Kg, IQR 48.65-67.8 and bodyfat(%) of 29.4%, IQR 22.225-34.75 Regarding aldosterone production, patients with OSA had a median basal aldosterone of 217.5 pg/mL, IQR 164-287.5, a median potassium of 3.1 mmol/L, IQR 2.9-3.5 and lateralized disease in 60%, 95 CI 32.3-83.7. Patients without OSA had a median basal aldosterone of 141 pg/mL, IQR 102.5-207, a median potassium of 4 mmol/L, IQR 3.55-4.2 and lateralized disease in 52.6%, 95 CI 28.9-75.6. Conclusions: The project is still ongoing, with higher numerosity and further analysis needed, but the higher basal aldosterone concentration and lower potassium found in patients affected by OSA could suggest a stronger phenotype, and a higher aldosterone could lead to the development of Obstructive Sleep Apnea.