Association of primary aldosteronism with severe sleep apnea and correlation between post-treatment renin activity and amount of change in respiratory event index during sleep

Yonekazu Kidawara; Manabu Kadoya; Masataka Igeta; Miki Kakutani-Hatayama; Akiko Morimoto; Akio Miyoshi; Akinori Kanzaki; Kosuke Konishi; Takashi Daimon; Hidenori Koyama

doi:10.5664/jcsm.11788

Association of primary aldosteronism with severe sleep apnea and correlation between post-treatment renin activity and amount of change in respiratory event index during sleep

J Clin Sleep Med. 2025 Jun 26. doi: 10.5664/jcsm.11788. Online ahead of print.

Affiliations

¹ Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
² Department of Biostatistics, School of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan.

PMID: 40566973
DOI: 10.5664/jcsm.11788

Abstract

Study objectives: Sleep apnea occurs more often in patients with primary aldosteronism (PA), while unsuppressed plasma renin activity (PRA) after treatment is associated with a lower risk of cardiovascular events. However, the relationship between PA and severe sleep apnea remains unclear, and it is not known whether PRA following treatment is associated with an apnea condition in affected patients.

Methods: Cross-sectional relationships between PA (n=176 affected patients) and severe sleep apnea, classified by respiratory event index (REI) obtained with use of an apnomonitor, were examined, with the results compared to those of patients with essential hypertension (EH) (n=418). Additionally, the correlation between PRA at follow-up and change in REI findings obtained at baseline and follow-up examinations was analyzed in 45 patients with PA, stratified based on treatment status.

Results: PA was found to be significantly associated with severe sleep apnea as compared to EH, even after adjustment for other clinical risk factors (odds ratio 2.08, 95% confidence interval 1.09-3.95, p = 0.025). Furthermore, post-treatment PRA showed a significantly negative correlation with change in REI from before to after treatment (r = -0.550, p = 0.004).

Conclusions: As compared to EH patients, those with PA had a higher prevalence of severe sleep apnea. Furthermore, a significantly negative correlation of post-treatment PRA with change in REI from before to after treatment was noted.

Keywords: plasma renin activity; primary aldosteronism; sleep apnea.