CSEMO2 - CSEM: Endocrinology & Metabolism Oral Abstracts: The Prevalence of Primary Aldosteronism in Patients with Hypertension and Obstructive Sleep Apnea: A Prospective Cohort Study

Blinded Abstract:

Background: The reported prevalence of primary aldosteronism (PA) among patients diagnosed with obstructive sleep apnea (OSA) is approximately 27%.

Methods: A prospective cohort study was conducted from 2021 to 2024 in Sherbrooke, Canada. All hypertensive patients newly diagnosed with OSA through sleep polygraphy at our university center were recruited to be screened for PA with an aldosterone-to-renin ratio (ARR). Confirmatory testing was performed in cases of abnormal screening results. The primary objective of the study was to determine the prevalence of HAP among hypertensive patients diagnosed with OSA. We did this to ascertain the relevance of systematically screening the hypertensive OSA population for PA and to evaluate the feasibility of such screening at our center.

Results: Of the 139 patients who completed PA screening, 12.2% (n = 17) were diagnosed with PA and 5% (n = 7) had abnormal screening results with negative confirmatory testing (mild dysregulated aldosterone secretion [MDAS]). Simple logistic regression analysis revealed that age, sex, body mass index, number of antihypertensive medications, creatinine, and apnea-hypopnea index did not significantly impact the prevalence of confirmed PA. However, Hypokalemia tripled the risk of PA (OR = 3.01 [1.07 - 8.89]; p = 0.038), particularly for levels below 3.4 mmol/L.

Conclusion: In our center, the estimated prevalence of confirmed PA and MDAS in hypertensive patients with newly diagnosed OSA was 12.2% and 5%, respectively, which is lower than that observed in the literature. Nevertheless, we suggest systematic screening for PA in all hypertensive patients with OSA, especially those with hypokalemia.