[The impact of primary aldosteronism treatment on the clinical outcome of coexisting obstructive sleep apnea].

Objective: To evaluate the effect of targeted therapy for primary aldosteronism (PA) on the clinical outcome of coexisting obstructive sleep apnea (OSA). Methods: A prospective study was conducted on patients diagnosed with both PA and OSA in the Sun Yat-sen Memorial Hospital between June 2023 and January 2025. All patients received PA targeted treatment. Full-night portable sleep monitoring was performed before and 3-12 months after treatment. Participants were divided into the OSA improvement group or the non-improvement group based on the change in the apnea-hypopnea index (AHI). Differences in clinical characteristics before and after PA treatment, as well as between the two patient groups, were compared. Multivariate logistic regression model was employed to identify risk factors influencing the lack of OSA improvement. Results: A total of 46 patients were enrolled, including 35 males and 11 females, with a mean age of (51.0±12.0) years. Among them, 34 patients were classified into the OSA improvement group, while 12 patients into the non-improvement group the non-improvement group. Of these, 21 patients underwent unilateral adrenalectomy, and 25 received mineralocorticoid receptor antagonist therapy. Patients were followed up for a duration of [M (Q1,Q3)] 6.0 (3.0,8.0) months. After treatment, patients with PA complicated by OSA exhibited a reduction in antihypertensive medication use, the increases in serum potassium, renin activity, and serum creatinine levels, along with the decreases in plasma aldosterone and the aldosterone-to-renin ratio (all P<0.05). Specifically, the AHI declined from 23.8 (9.0,40.2) events/h to 13.1 (8.1,21.8) events/h (P=0.003). In the non-improvement group, baseline body mass index [(30.1±6.4) vs (25.8±5.0) kg/m²] and the clinical non-remission rate of PA [6/12 vs 5.9% (2/34)] were both higher than those in the improvement group (both P<0.05). Multivariate logistic regression model analysis revealed that a higher baseline body mass index (OR=1.18, 95%CI: 1.01-1.39) and clinical non-remission of PA (OR=11.69, 95%CI: 2.13-64.08) were risk factors for lack of improvement in OSA. Conclusions: In patients with PA complicated by OSA, PA-targeted therapy effectively reduces OSA severity. Higher baseline body mass index and clinical non-remission of PA are identified as risk factors for unimproved OSA.