Relationship between Aldosterone and the Metabolic Syndrome in Patients with Obstructive Sleep Apnea Hypopnea Syndrome: Effect of Continuous Positive Airway Pressure Treatment

Barceló, Antònia; Piérola, Javier; Esquinas, Cristina; Peña, Mónica de la; Arqué, Meritxell; Alonso-Fernández, Alberto; Bauçà, Josep Miquel; Robles, Juan; Barceló, Bernardino; Barbé, Ferrán

doi:10.1371/journal.pone.0084362

Cited by 35 publications

(26 citation statements)

References 38 publications

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“…In fact, a number of reports have suggested that primary aldosteronism may be a common cause of hypertension, with prevalence estimates ranging from 6% to 20%, whereas among patients with resistant hypertension, the prevalence ranges from 20% to 36% [45,46]. Interestingly, recent studies also implicate aldosterone in the pathogenesis of metabolic syndrome [47]. Elevated aldosterone levels seem to lead not only to sodium retention and volume expansion, but also to increased inflammation and oxidative stress, which in turn promote insulin resistance, impaired pancreatic β-cell function, endothelial dysfunction and hypertension [48,49].…”

Section: Discussionmentioning

confidence: 99%

The effect of treatment for sleep apnoea on determinants of blood pressure control

et al. 2017

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Our aim was to assess the effect of continuous positive airway pressure (CPAP) on the nocturnal evolution of peripheral chemosensitivity, renin-angiotensin-aldosterone system activity, sympathetic tone and endothelial biomarkers in obstructive sleep apnoea (OSA) patients with isolated nocturnal hypertension (INH) or day-night sustained hypertension (D-NSH).In a crossover randomised trial, 32 OSA patients newly diagnosed with hypertension and without antihypertensive treatment were randomly assigned to 12 weeks of CPAP or sham CPAP. Peripheral chemosensitivity was evaluated before and after sleep using the hypoxic withdrawal test (%Δ).At baseline, D-NSH patients showed higher %Δ before sleep and higher levels of aldosterone and diurnal catecholamines. CPAP only reduced the nocturnal increase of %Δ in INH patients (6.9%, 95% CI 1.0-12.8%; p=0.026). CPAP-induced change from baseline in %Δ after sleep was 7.5% (95% CI 2.6-12.2%, p=0.005) in the INH group and 5.7% (95% CI 2.2-9.3%, p=0.004) in the D-NSH group. In contrast, %Δ before sleep only decreased with CPAP in the D-NSH patients (3.0%, 95% CI 0.5-5.6%; p=0.023).In conclusion, CPAP reduces the nocturnal increase of peripheral chemosensitivity experienced by INH patients and corrects the high daytime sensitivity of patients with D-NSH. Differences in response to CPAP between these patients can help better understand the mechanisms of perpetuation of hypertension in sleep apnoea.

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Section: Discussionmentioning

confidence: 99%

The effect of treatment for sleep apnoea on determinants of blood pressure control

et al. 2017

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“…Patients with OSA display high levels of serum aldosterone [67] and there is a correlation between aldosterone levels and worsening of apnoea-hypopnea index (AHI) [68,69]. Aldosterone excess may play a pivotal role in the pathophysiology of OSA and, on the other hand, OSA seems to increase aldosterone levels by activation of the renin-angiotensin-aldosterone system; this excess appears to be partially reversible with continuous positive airway pressure in patients with high aldosterone level at baseline [69].…”

Section: Prevalence Of Primary Aldosteronism In Special Populationmentioning

confidence: 99%

Is Primary Aldosteronism Still Largely Unrecognized?

et al. 2017

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Primary aldosteronism (PA) was first reported by Jerome W. Conn in 1954 when it was considered a rare disorder, only suspected in cases of hypertension and spontaneous hypokalemia. Over the last 30 years, with the wide application of the plasma aldosterone to plasma renin activity ratio as screening test, the clinical spectrum of PA has dramatically changed. Different studies displayed significant differences in term of patients investigated, diagnostic criteria and hormonal assays; however, large prospective studies with robust diagnostic criteria indicated that the prevalence of PA is around 6% of the general hypertensive population and 11% of the patients referred to hypertension centers. In light of these epidemiological studies, the Endocrine Society Guideline recommends the screening for PA of around 50% of patients with hypertension, and identifies the categories of patients at high risk for the disease. However, clinical data obtained from “real-life” show that the screening rate is much lower and PA remains an under-diagnosed and under-treated cause of secondary hypertension with an associated increased risk of cardio- and cerebrovascular mortality and morbidity.

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“…The effect of aldosterone on MetSyn in other conditions has however been studied. Higher significant levels were found in MetSyn participants compared to non-MetSyn subjects among patients with obstructive sleep apnea hypopnea syndrome (OSAHS) [33]. Similarly, a cross-sectional study conducted in 356 participants from 69 families of African descent Seychelles found aldosterone to be independently associated with metabolic syndrome [34].…”

Section: Discussionmentioning

confidence: 98%

Metabolic Syndrome among Ischaemic Stroke Patients in Ghana: The Possible Role of Renin and Aldosterone

Yeboah¹,

Nkum²,

Amankwaa³

et al. 2017

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Background: Both metabolic syndrome (MetSyn) and the Renin Angiotensin Aldosterone System (RAAS) are predictors of adverse outcomes in stroke patients. This study aimed at evaluating the association between RAAS and MetSyn among ischaemic stroke subjects in a tertiary hospital of Ghana from September 2015 to June 2016. Methodology: The study purposively recruited 252 Ghanaians comprising 132 ischaemic stroke patients and 120 apparently healthy control subjects. The participants were subjected to measurements of plasma renin, serum aldosterone, lipid profile, anthropometries and blood pressure. Results: MetSyn prevalence among the stroke subjects compared to the controls were 50.0% vs 8.3% (NCEP/ATP III), 71.2% vs 9.2 (IDF) and 71.2% vs 6.7% (H_MS). Both renin and aldosterone were significantly (p < 0.05) higher in the ischaemic stroke subjects [(1.8 ± 0.1 vs 1.4 ± 0.1) pg/ml and (2.9 ± 0.2 vs 2.3 ± 0.2) pg/ml respectively]. Adjusting for age, gender, diabetes status and hypertension, third tertile (T 3 ) aldosterone (aOR = 2.7, p = 0.008), obesity (aOR = 11.7, p = 0.004) and high triglyceride (aOR = 5.3, p < 0.001) but not renin (aOR = 6.1, p = 0.742) were independently associated with increasing odds of metabolic syndrome. Moreover, there was a significant (p < 0.050) correlation between plasma renin and waist circumference How to cite this paper: Yeboah, F.A., Nkum, B., Amankwaa, B., Eghan Jr., B.A., Acheampong, E., Nsiah, P., Okyere, P., Owusu, L., Nsenba, E.B. and Anto, E.O. (WC) (r = 0.493) and high density lipoprotein (HDL) (r = −0.319). Significant (p < 0.050) correlations also existed between serum aldosterone and WC (r = 0.588), waist-to-height ratio (WHR) (r = 0.503), body mass index (BMI) (r = 0.691), HDL (r = −0.317), total cholesterol (r = 0.678) and triglyceride (r = 0.439). Conclusion: Aldosterone and not renin could play significant role in the pathophysiology of metabolic syndrome in ischaemic stroke. These findings underpin the observations that aldosterone is associated with several cardiovascular risk factors and may exacerbate metabolic defects in people with ischaemic stroke. Adequate aldosterone blockade could therefore mitigate the development and progression of metabolic syndrome in ischaemic stroke subjects.

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Relationship between Aldosterone and the Metabolic Syndrome in Patients with Obstructive Sleep Apnea Hypopnea Syndrome: Effect of Continuous Positive Airway Pressure Treatment

Cited by 35 publications

References 38 publications

The effect of treatment for sleep apnoea on determinants of blood pressure control

The effect of treatment for sleep apnoea on determinants of blood pressure control

Is Primary Aldosteronism Still Largely Unrecognized?

Metabolic Syndrome among Ischaemic Stroke Patients in Ghana: The Possible Role of Renin and Aldosterone

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