Table 4.

Effect of aldosterone inhibition on OSA.

Author	Nation	Study design	Subjects	Intervention	Follow-up (months)	Outcome
Krasińska (48)	Poland	RCT	102 RHTN and OSA patients (n = 51 per group)	Therapy group: additional use of eplerenone (50 mg/daily)	6	Nighttime BP parameters, left ventricular hypertrophy, AHI, PAC ↓
				Control group: standard antihypertensive agents
Yang (44)	China	RCT	30 RHTN and OSA patients (n = 15 per group)	Therapy group: additional spironolactone 20 mg once daily or 40 mg once their BP remains uncontrolled at 4 weeks	3	AHI, BP, and PAC ↓
				Control group: usual antihypertensive agents
Krasińska (45)	Poland	Observational	31 RHTN and OSA patients	Eplerenone at a dose of 50 mg/day with a standard antihypertensive therapy	3	AHI, neck circumference, BP, aortic pulse wave, and arterial wall stiffness ↓
Kasai (46)	Canada	Observational	16 OSA patients with uncontrolled HTN	Intensified diuretic therapy (metolazone 2.5 mg and spironolactone 25 mg daily for 7 days after which the daily dose was doubled for 7 additional days)	2 weeks	AHI, BP, overnight change in leg fluid volume and overnight change in neck circumference ↓
Gaddam (47)	America	Observational	12 RHTN and OSA patients	Additional therapy (spironolactone 25 mg once daily and force-titrated to 50 mg once daily at 4 weeks)	2	Body weight, BP, AHI ↓ and PRA ↑, a tended but insignificant reduction neck circumference

OSA, obstructive sleep apnea; HTN, hypertension; RHTN, resistant hypertension; AHI, apnea–hypopnea index; BP, blood pressure; PAC, plasma aldosterone concentration; PRA, plasma renin activity; RCT, randomized controlled trial; ↑, significantly increase; ↓, significantly decrease; →, insignificant change.