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Does continuous positive airway pressure reduce aldosterone levels in patients with obstructive sleep apnea?

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Aldosterone is associated with the development of obstructive sleep apnea (OSA) and cardiovascular diseases. Continuous positive airway pressure (CPAP) is an effective treatment for OSA, but the impact of CPAP therapy on aldosterone levels in patients with OSA remains unclear. To address this issue, a meta-analysis was conducted to evaluate the effects of CPAP therapy on serum aldosterone levels in OSA.

Methods

Two reviewers independently searched PubMed, Cochrane library, Embase, and Web of Science before March 2015. Information on characteristics of subjects, study design, and pre- and post-CPAP treatment of serum aldosterone was extracted for analysis. Standardized mean difference (SMD) was calculated to estimate the treatment effects of CPAP therapy.

Results

A total of 5 studies involving 329 patients were pooled into this meta-analysis, including 3 observational studies and 2 randomized controlled studies. Results indicated significantly decreased aldosterone levels after CPAP therapy (SMD = −0.236, 95 % confidence interval (CI) = −0.45 to −0.02, z = 2.12, p = 0.034).

Conclusions

This meta-analysis suggested that CPAP therapy was associated with a decrease in serum aldosterone in patients with OSA. Further large-scale, well-designed interventional investigations are needed to clarify this issue.

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References

  1. Parish JM, Somers VK (2004) Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 79(8):1036–1046

    Article  PubMed  Google Scholar 

  2. Lavie P, Herer P, Hoffstein V (2000) Obstructive sleep apnoea syndrome as a risk factor for hypertension: population study. Br Med J 320(7233):479–482. doi:10.1136/bmj.320.7233.479

    Article  CAS  Google Scholar 

  3. Grote L, Ploch T, Heitmann J, Knaack L, Penzel T, Peter JH (1999) Sleep-related breathing disorder is an independent risk factor for systemic hypertension. Am J Respir Crit Care Med 160(6):1875–1882

    Article  CAS  PubMed  Google Scholar 

  4. Fletcher EC (2003) Sympathetic over activity in the etiology of hypertension of obstructive sleep apnea. Sleep 26(1):15–19

    PubMed  Google Scholar 

  5. Somers VK, Dyken ME, Clary MP, Abboud FM (1995) Sympathetic neural mechanisms in obstructive sleep-apnea. J Clin Investig 96(4):1897–1904. doi:10.1172/jci118235

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Jelic S, Padeletti M, Kawut SM, Higgins C, Canfield SM, Onat D, Colombo PC, Basner RC, Factor P, LeJemtel TH (2008) Inflammation, oxidative stress, and repair capacity of the vascular endothelium in obstructive sleep apnea. Circulation 117(17):2270–2278. doi:10.1161/circulationaha.107.741512

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Dudenbostel T, Calhoun DA (2012) Resistant hypertension, obstructive sleep apnoea and aldosterone. J Hum Hypertens 26(5):281–287. doi:10.1038/jhh.2011.47

    Article  CAS  PubMed  Google Scholar 

  8. Pratt-Ubunama MN, Nishizaka MK, Boedefeld RL, Cofield SS, Harding SM, Calhoun DA (2007) Plasma aldosterone is related to severity of obstructive sleep apnea in subjects with resistant hypertension. Chest 131(2):453–459. doi:10.1378/chest.06-1442

    Article  CAS  PubMed  Google Scholar 

  9. Vasan RS, Evans JC, Larson MG, Wilson PWF, Meigs JB, Rifai N, Benjamin EJ, Levy D (2004) Serum aldosterone and the incidence of hypertension in nonhypertensive persons. N Engl J Med 351(1):33–41. doi:10.1056/NEJMoa033263

    Article  CAS  PubMed  Google Scholar 

  10. Lozano L, Luis Tovar J, Sampol G, Romero O, Jose Jurado M, Segarra A, Espinel E, Rios J, Dolores Untoria M, Lloberes P (2010) Continuous positive airway pressure treatment in sleep apnea patients with resistant hypertension: a randomized, controlled trial. J Hypertens 28(10):2161–2168. doi:10.1097/HJH.0b013e32833b9c63

    Article  CAS  PubMed  Google Scholar 

  11. Martinez-Garcia M-A, Capote F, Campos-Rodriguez F, Lloberes P, Diaz de Atauri MJ, Somoza M, Masa JF, Gonzalez M, Sacristan L, Barbe F, Duran-Cantolla J, Aizpuru F, Manas E, Barreiro B, Mosteiro M, Cebrian JJ, de la Pena M, Garcia-Rio F, Maimo A, Zapater J, Hernandez C, SanMarti NG, Montserrat JM (2013) Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. Jama-J Am Med Assoc 310(22):2407–2415. doi:10.1001/jama.2013.281250

    Article  CAS  Google Scholar 

  12. Pedrosa RP, Drager LF, de Paula LK, Amaro AC, Bortolotto LA, Lorenzi-Filho G (2013) Effects of OSA treatment on BP in patients with resistant hypertension: a randomized trial. Chest 144(5):1487–1494. doi:10.1378/chest.13-0085

    Article  CAS  PubMed  Google Scholar 

  13. Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N, Mullins R, Jenkinson C, Stradling JR, Davies RJO (2002) Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 359(9302):204–210. doi:10.1016/s0140-6736(02)07445-7

    Article  PubMed  Google Scholar 

  14. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. doi:10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12. doi:10.1016/0197-2456(95)00134-4

    Article  CAS  PubMed  Google Scholar 

  16. Acelajado M, Pisoni R, Calhoun DA (2010) Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) does not reduce aldosterone levels in hypertensive patients. J Investig Med 58(2):426

    Google Scholar 

  17. Tamisier R, Lacedonia D, Monneret D, Baguet JP, Levy P, Jean-Louis Pepin JL (2010) Effects of CPAP and valsartan randomly assigned on baroreflex function and aldosterone in hypertensive OSAS [abstract]. European Respiratory Society Annual Congress, Barcelona, Spain, September 18–22:[1663]

  18. Akashiba T, Otsuka K, Yoshizawa T, Kurashina K, Kawamura T, Sasaki I, Hosokawa Y, Horie T (1991) Effects of nasal continuous positive airway pressure (NCPAP) on nocturnal renal function in obstructive sleep apnea syndrome (OSAS). Nihon Kyobu Shikkan Gakkai Zasshi 29(5):573–577

    CAS  PubMed  Google Scholar 

  19. Follenius M, Krieger J, Krauth MO, Sforza F, Brandenberger G (1991) Obstructive sleep apnea treatment: peripheral and central effects on plasma renin activity and aldosterone. Sleep 14(3):211–217

    CAS  PubMed  Google Scholar 

  20. Svatikova A, Olson LJ, Wolk R, Phillips BG, Adachi T, Schwartz GL, Somers VK (2009) Obstructive sleep apnea and aldosterone. Sleep 32(12):1589–1592

    PubMed  PubMed Central  Google Scholar 

  21. Zhang XL, Li YQ (2009) Efficacy of continuous positive airway pressure therapy upon resistant hypertension in patients with obstructive sleep apnea hypopnea syndrome. Zhonghua yi xue za zhi 89(26):1811–1814

    CAS  PubMed  Google Scholar 

  22. Xiao Y, Yin K, Zheng P (2000) Significance of the changes of urinary uric acid, ANP, renin and aldosterone in sleep apnea syndrome patients. Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chin J Tuberc Respir Dis 23(1):27–30

    CAS  Google Scholar 

  23. Saarelainen S, Hasan J, Siitonen S, Seppala E (1996) Effect of nasal CPAP treatment on plasma volume, aldosterone and 24-h blood pressure in obstructive sleep apnoea. J Sleep Res 5(3):181–185

    Article  CAS  PubMed  Google Scholar 

  24. Meston N, Davies RJO, Mullins R, Jenkinson C, Wass JAH, Stradling JR (2003) Endocrine effects of nasal continuous positive airway pressure in male patients with obstructive sleep apnoea. J Intern Med 254(5):447–454. doi:10.1046/j.1365-2796.2003.01212.x

    Article  CAS  PubMed  Google Scholar 

  25. Moller DS, Lind P, Strunge B, Pedersen EB (2003) Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens 16(4):274–280

    Article  CAS  PubMed  Google Scholar 

  26. Barcelo A, Pierola J, Esquinas C, de la Pena M, Arque M, Alonso-Fernandez A, Bauca JM, Robles J, Barcelo B, Barbe F (2014) Relationship between aldosterone and the metabolic syndrome in patients with obstructive sleep apnea hypopnea syndrome: effect of continuous positive airway pressure treatment. PLoS One 9(1):e84362. doi:10.1371/journal.pone.0084362

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lloberes P, Sampol G, Espinel E, Segarra A, Ramon MA, Romero O (2014) A randomized controlled study of cpap effect on plasma aldosterone concentration in patients with resistant hypertension and obstructive sleep apnea. J Hypertens 32(8):1650–1657

    Article  CAS  PubMed  Google Scholar 

  28. Connell JMC, Davies E (2005) The new biology of aldosterone. J Endocrinol 186(1):1–20. doi:10.1677/joe.1.06017

    Article  CAS  PubMed  Google Scholar 

  29. Williams JS, Williams GH (2003) 50th anniversary of aldosterone. J Clin Endocrinol Metab 88(6):2364–2372. doi:10.1210/jc.2003-030490

    Article  CAS  PubMed  Google Scholar 

  30. Pimenta E, Calhoun DA, Oparil S (2009) Sleep apnea, aldosterone, and resistant hypertension. Prog Cardiovasc Dis 51(5):371–380. doi:10.1016/j.pcad.2008.02.004

    Article  CAS  PubMed  Google Scholar 

  31. Goodfriend TL (2008) Obesity, sleep apnea, aldosterone, and hypertension. Curr Hypertens Rep 10(3):222–226. doi:10.1007/s11906-008-0042-x

    Article  CAS  PubMed  Google Scholar 

  32. Patel SR, White DP, Malhotra A, Stanchina ML, Ayas NT (2003) Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea—results of a meta-analysis. Arch Intern Med 163(5):565–571. doi:10.1001/archinte.163.5.565

    Article  PubMed  Google Scholar 

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Acknowledgment

This work was supported by grant 2013-2-88 for Youth Research Fund from Fujian Province Health Bureau.

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Authors and Affiliations

  1. College of Medicine, Department of Respiratory Medicine, Xiamen University, No. 201-209, Hubin South Road, SiMing District, Xiamen, Fujian Province, 351004, People’s Republic of China

    Si-jiu Yang

  2. Department of Respiratory Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China

    Xing-Tang Jiang, Xiao-Bin Zhang, Xiao-Wen Yin & Wei-Xian Deng

  3. Teaching Hospital of FuJian Medical University, Xiamen, China

    Xing-Tang Jiang, Xiao-Bin Zhang, Xiao-Wen Yin & Wei-Xian Deng

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  1. Si-jiu Yang
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Correspondence to Xing-Tang Jiang.

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Yang, Sj., Jiang, XT., Zhang, XB. et al. Does continuous positive airway pressure reduce aldosterone levels in patients with obstructive sleep apnea?. Sleep Breath 20, 921–928 (2016). https://doi.org/10.1007/s11325-015-1311-y

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  • DOI: https://doi.org/10.1007/s11325-015-1311-y

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