Case Detection Testing for Primary Aldosteronism in Male Patients with Hypertension and Snoring

Objectives: Coexistence of primary aldosteronism and obstructive sleep apnea in hypertension is evidenced. However, aldosterone and renin activity is varying with apnea/hypopnea index changes in subjects with resistant hypertension. Thus, the aim is to investigate the optional cutoff value for aldosterone/renin activity to screen primary aldosteronism in patients with different status of apnea/hypopnea index. Methods: 271 hypertensive male snores were evaluated via polysomnography and divided into two groups, group with apnea/hypopnea index >15 events/h and with apnea/hypopnea index 15 ng/dL performed saline infusion test, after which aldosterone concentration>5 ng/dL was a sign of primary aldosteronism. Receiver operating characteristic curve was applied to explore appropriate cutoff value for aldosterone/renin activity. Results: 39 (14.4%) of the 271 were diagnosed with primary aldosteronism including 15 with apnea/hypopnea index 15 events/h. Area under receiver operating characteristic curve was 0.97 (95%CI 0.94-0.99) in the group with apnea/hypopnea index >15 events/h and 0.91 (95%CI 0.87-0.96) in the group with apnea/hypopnea index 15 events/h with sensitivity 100%, specificity 69.7%. Youden index is 0.9 for the group with apnea/hypopnea index 15 events/h. Conclusions: Optional cutoff values of aldosterone/renin activity to screening for primary aldosteronism should be considered in patients with different status of apnea/hypopnea index.