Table Of Content
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2 Defining OSAHS
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3 The diagnosis value of PA among different indicators by ROC graph curves
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Medical genetics
It is important to note that while these indicators can be utilized in settings with limited resources, they are not substitutes for definitive diagnostic tests. Among the 241 patients included in the study, 66 were diagnosed with PA. We found that ARR, across all patients, and PAC, especially in those with severe OSAHS, displayed moderate predictive utility for PA. In contrast, PRA exhibited limited predictive capacity for PA diagnosis, lacking sufficient diagnostic value compared to ARR and PAC.
1 Baseline characteristics of the study population
Conversely, intermittent hypoxia caused by OSAHS might, in turn, exacerbate RAAS activation. Besides, significantly increased secretion of cortisol in patients with PA, independent of PA subtype or adenoma tissue genotypes, could also increase the risk of OSAHS (25, 26). The ROC curves of PAC (A), ARR (B) and PRA (C) at screening for the prediction of PA. ARR, plasma aldosterone-renin ratio; PAC, plasma aldosterone concentration; PA, primary aldosteronism; PRA, plasma renin activity; ROC, receiver operating characteristic.
Several limitations should be acknowledged when interpreting the findings of our study. First, this study was a single-center, cross-sectional observational study, and inevitable bias may affect the authenticity of the results, potentially weakening their reliability. Second, due to the lack of uniformity in diagnostic protocols and assay methods for measuring the ARR in different medical centers (17), the resulting cutoff values may vary substantially, limiting the generalization of the results of this study. Multi-center research is needed to further verify our findings among a broader population. Third, in some cases, when patients had only one positive result in CCT and SIT, and expressed a strong desire for surgery, we performed adrenal vein sampling (AVS) on them.
Patients willing to undergo adrenalectomy were subjected to adrenal venous sampling (AVS), and the criteria used to determine the lateralization of aldosterone hypersecretion were established according to guideline (17). The studies involving humans were approved by the Ethics Committee of the Ji'an Central Hospital (No.063056). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. One of the most effective ways to boost your confidence is to mentor others.
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Future studies will adhere more closely to diagnostic criteria guided by clinical guidelines. Lastly, our study was conducted in a single tertiary hospital center and involved a highly selected population. Therefore, our results need to be tested in a broader population to enhance their applicability and generalizability. The current study focused on patients at high risk of PA, specifically those with moderate and severe OSAHS combined with RH, and found that the prevalence of PA in this population was as high as approximately 27%. Our findings shed light on the diagnostic potential of the ARR and PAC as screening tools, with differential ARR cutoff values identified for diagnosing PA in patients with moderate and severe OSAHS (45 for moderate OSAHS and 42 for severe OSAHS). The lower ARR cutoff value for severe OSAHS suggested a higher risk of PA in this population, indicating that patients with more severe OSAHS might require earlier intervention for PA.
1 Study design and population selection
Before blood pressure measurement, the patients were asked to rest quietly for at least 5 min in a quiet, comfortable environment. The individual should sit in a comfortable chair with their back supported and their arm positioned at heart level. Upper arm medical electronic blood pressure monitor (Omron HEM-7132) was used to measure blood pressure. When measuring blood pressure, the measurement should be repeated 1–2 min apart, and the average of the two readings should be recorded.
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OSAHS-induced intermittent hypoxia leads to increased sympathetic activity, resulting in activation of the renin-angiotensin-aldosterone system (RAAS), which increases the risk of hypertension (3). Primary aldosteronism (PA) is a disorder in which the zona glomerulosa of the adrenal cortex abnormally secretes aldosterone hormone, resulting in elevated plasma aldosterone concentrations and decreased plasma renin activity. PA is considered a common cause of secondary RH (6), the prevalence of which ranges from 3% to 13% in the overall population (7, 8).
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Those confirmed by AVS with bilateral or unilateral excessive secretion of aldosterone were diagnosed with primary aldosteronism (PA). However, it should be acknowledged that this diagnostic criterion carries some degree of scientific uncertainty. The AVS examination is typically used for subtype classification rather than confirming the diagnosis of PA itself.
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Using 45 as the cutoff value for ARR at screening, we achieved a sensitivity of 52% and a specificity of 86%, a positive predictive value of 87%, and a negative predictive value of 50%. The optimal cutoff value for PAC was 17, with a relatively lower specificity (78%) than ARR, a sensitivity of 55%, a positive predictive value of 82%, and a negative predictive value of 49% (Table 3). Among the three indicators, ARR at screening, and PAC at screening exhibited potential for the diagnosis of PA in patients with moderate and severe OSAHS combined with RH. OSAHS is recognized as a contributing factor to hypertension and holds a pivotal role in cases of resistant hypertension (RH) (3). A substantial prevalence of OSAHS exists among individuals with RH, with suggestions attributing the hormone aldosterone as a potential contributor to the resistance observed in this population (4).
