Table 2.
The prevalence of PA among OSA.
| Author | Study design | Nation | Subjects | Assessment of PA | Assessment of OSA | Prevalence of PA |
|---|---|---|---|---|---|---|
| Dobrowolski (23) | Prospective | Poland | 94 moderate/severe OSA and HTN | Confirmed by SIT (aldosterone level > 10 ng/dl) plus low baseline PRA | PSG (AHI ≥ 15) | 21.30% |
| Chee (22) a | Prospective | Australia | 40 OSA and HTN | Only screening test performed [ARR > 70 pmol/mU (approximate 20 ng/dl: ng/ml/h)] | PSG (AHI ≥ 5) | 5% had likely PA and 22.5% had possible PA |
| Buffolo (13) | Cross-sectional, multiethnic, multicenter | Europe | 102 patients with OSA and HTN | PA was diagnosed according to the 2016 ES guideline. Different centers have different standards for the screening test and confirmatory test | Cardiorespiratory polygraphy (AHI ≥ 5) | 11.80% |
| China | 101 patients with OSA and HTN | Same as above | Same as above | 5.90% | ||
| Wang (14) | Cross-sectional study | China | 888 patients with OSA and HTN | A suppressed PRA (<1.0 μg/L/h) and an elevated aldosterone level (>12 ng/L) or an elevated ARR (>20 ng/dl: ng/ml/h) and a confirmation test by SIT (aldosterone level was >5 ng/dl) | PSG (AHI ≥ 5) | 16.55% |
| Di Murro (21) | Prospective | Italy | 53 OSA and HTN | ARR >40 (ng/dl: ng/ml/h) in the presence of PAC >15 ng/dl and suppressed PRA and confirmatory test [SIT (PAC >5 ng/dl)] | Only those have features of OSA and ESS ≥10 underwent PSG (AHI ≥ 5) | 34% |
| Calhoun (20) | Prospective | USA | 114 RHTN (72 subjects had a high probability and 42 subjects had a low probability of having sleep apnea) | PA was defined as a suppressed PRA (<1.0 ng/mL/h) and elevated 24-h UAldo >12 μg in the setting of high dietary sodium ingestion (>200 mEq/24 h) | Berlin questionnaire | Subjects at high risk for sleep apnea were almost two times more likely to have PA diagnosed (36% vs. 19%, P < 0.05) |
OSA, obstructive sleep apnea; HTN, hypertension; RHTN, resistant hypertension; PA, primary aldosteronism; PSG, polysomnography; ESS, Epworth Sleepiness Scale; AHI, apnea–hypopnea index; PAC, plasma aldosterone concentration; PRA, plasma renin activity; ARR, aldosterone-to-renin ratio; UAldo, urine aldosterone level; SIT, the saline infusion test.
a
This study inferred that the likelihood and possibility of PA in hypertensive OSA patients were 5% and 22.5% mainly based on the results of screening test and usage of antihypertensive agents, because no one completed the confirmation test.