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Original Research: Sleep Disorders |

Increased Dietary Sodium Is Related to Severity of Obstructive Sleep Apnea in Patients With Resistant Hypertension and HyperaldosteronismSalt and Sleep Apnea

Eduardo Pimenta, MD, PhD; Michael Stowasser, MBBS, PhD; Richard D. Gordon, MBBS, PhD; Susan M. Harding, MD; Michel Batlouni, MD, PhD; Bin Zhang, PhD; Suzanne Oparil, MD; David A. Calhoun, MD
Author and Funding Information

From the Endocrine Hypertension Research Centre and Clinical Centre of Research Excellence in Cardiovascular Disease and Metabolic Disorders (Drs Pimenta, Stowasser, and Gordon), The School of Medicine, The University of Queensland, Princess Alexandra and Greenslopes Private Hospitals, Brisbane, QLD, Australia; Dante Pazzanese Institute of Cardiology (Drs Pimenta and Batlouni), São Paulo, Brazil; Sleep/Wake Disorders Center (Drs Harding and Calhoun), Division of Pulmonary, Allergy and Critical Care Medicine, and Vascular Biology and Hypertension Program (Drs Oparil and Calhoun), The University of Alabama at Birmingham, Birmingham, AL; and Division of Biostatistics and Epidemiology (Dr Zhang), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.

Correspondence to: David Calhoun, The University of Alabama at Birmingham, 1530 3rd Ave S, Birmingham, AL 35294-1150; e-mail: dcalhoun@uab.edu


Funding/Support: This work was supported by National Heart, Lung, and Blood Institute [Grants HL075614 and SCCOR P50 HL077100 (to Dr Calhoun)] and National Institutes of Health National Center for Research Resources [Grant 5UL1 RR025777-04].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):978-983. doi:10.1378/chest.12-0802
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Background:  Obstructive sleep apnea (OSA) is a strong and independent risk factor for the development of hypertension, particularly resistant hypertension, and cardiovascular diseases. Patients with resistant hypertension have a high prevalence of OSA in association with elevated aldosterone levels, high salt intake, and salt-sensitive BP. The objective of this study was to determine whether dietary salt and aldosterone are associated with severity of OSA in patients with resistant hypertension.

Methods:  Ninety-seven patients with resistant hypertension were prospectively evaluated by overnight polysomnography and 24-h urinary sodium and aldosterone levels while maintaining their usual diet. Hyperaldosteronism was defined as a plasma renin activity of < 1 ng/mL/h and urinary aldosterone level of ≥ 12 μg/24 h.

Results:  Overall, patients’ mean clinic BP was 156.3 ± 22.4/88.9 ± 13.3 mm Hg while taking an average of 4.3 ± 1.1 antihypertensive medications. Prevalence of OSA was 77.3%. Twenty-eight (28.9%) patients had hyperaldosteronism. Urinary sodium level was an independent predictor of severity of OSA only in patients with hyperaldosteronism.

Conclusions:  The findings suggest that dietary salt is related to the severity of OSA in patients with resistant hypertension and hyperaldosteronism. The results support dietary salt restriction as a treatment strategy for reduction of OSA severity in these patients.


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