Spironolactone reduces severity of obstructive sleep apnoea in patients with resistant hypertension: a preliminary report

Abstract

Obstructive sleep apnoea (OSA) and hyperaldosteronism are very common in subjects with resistant hypertension. We hypothesized that aldosterone-mediated chronic fluid retention may influence OSA severity in patients with resistant hypertension. We tested this in an open-label evaluation by assessing the changes in the severity of OSA in patients with resistant hypertension after treatment with spironolactone. Subjects with resistant hypertension (clinical blood pressure (BP) >or=140/90 mm Hg on >or=3 antihypertensive medications, including a thiazide diuretic and OSA (defined as an apnoea-hypopnoea index (AHI) >or=15) had full diagnostic, polysomnography before and 8 weeks after spironolactone (25-50 mg a day) was added to their ongoing antihypertensive therapy. In all, 12 patients (mean age 56 years and body mass index 36.8 kg m(-2)) were evaluated. After treatment with spironolactone, the AHI (39.8+/-19.5 vs 22.0+/-6.8 events/h; P<0.05) and hypoxic index (13.6+/-10.8 vs 6.7+/-6.6 events/h; P<0.05), weight and clinic and ambulatory BP were significantly reduced. Plasma renin activity (PRA) and serum creatinine were significantly higher. This study provides preliminary evidence that treatment with a mineralocorticoid receptor antagonist substantially reduces the severity of OSA. If confirmed in a randomized assessment, it will support aldosterone-mediated chronic fluid retention as an important mediator of OSA severity in patients with resistant hypertension.

Figure

Changes in apnea-hypopnea index (AHI) (39.8 ± 19.5 vs. 22.0 ± 6.8); hypoxic index (HI) (13.6 ± 10.8 vs. 6.7 ± 6.6); supine AHI (63.2 ± 28.7 vs. 40.8 ± 19.3); rapid eye movement sleep (REM) AHI (55.7 ± 27.9 vs. 33.9 ± 19.7) at 8 weeks (light grey bars) compared to baseline (dark grey bars). Values, mean ± SD. *Different compared to baseline, P < .05.