Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Mar 17:10:2048004021992191.
doi: 10.1177/2048004021992191. eCollection 2021 Jan-Dec.

Continuous positive airway pressure therapy reduces the levels of catecholamines and blood pressure in pseudophaeochromocytoma with coexisting obstructive sleep apnoea

Gie Ken-Dror  1 , Michael Wood  2 , David Fluck  3 , Pankaj Sharma  1 , Christopher H Fry  4 , Thang S Han  1   5
Affiliations
Review

Continuous positive airway pressure therapy reduces the levels of catecholamines and blood pressure in pseudophaeochromocytoma with coexisting obstructive sleep apnoea

Gie Ken-Dror et al. JRSM Cardiovasc Dis. .

Abstract

Background: Stress from obstructive sleep apnoea (OSA) stimulates catecholamine release and consequently can exacerbate hypertension, even in the absence of a catecholamine-producing tumour (phaeochromocytoma). As such, a positive screening test for suspected phaeochromocytoma may be misleading. There exists only a handful case reports, and no controlled trials, how continuous positive airway pressure (CPAP) to treat OSA influences catecholamine levels. We examined changes to levels of urinary catecholamine and blood pressure in response to CPAP treatment.

Methods: We conducted a meta-analysis of data aggregated from published case reports of individual patient data up to April 2020. The quality of the reports was evaluated using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool.

Results: A total of 13 cases (seven men and six women) from seven reports met our search criteria. Patients had mean age of 49.1 years (range = 36-62) and body mass index of 37.4 kg/m2 (range = 27-56). Most had moderate to severe OSA with CPAP treatment. Nine cases had 24-hour urinary noradrenaline assessment before and after CPAP treatment. CPAP treatment led to a 21% reduction (104 nmol/24-hours, 95% credible interval =59 to 148) in 24-hour urinary noradrenaline to within reference ranges, and 25% reduction (from 131 to 100 mmHg) in mean arterial pressure. The risk of overall bias evaluated by the ROBINS-I tool was found to be low in the majority of reports.

Conclusions: Investigations of patients suspected of phaeochromocytoma, particularly obese individuals, should exclude OSA and treat this condition if present before performing screening tests to assess for catecholamine levels.

Keywords: Hypertension; obesity; stress hormones; sympathetic activity.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
QUORUM flow chart of literature search.
Figure 2.
Figure 2.
Noradrenaline levels before (○) and after CPAP treatment (●) for individual cases and for pooled results (□open square = before CPAP treatment, ▪ solid square = after CPAP treatment). Noradrenaline levels were reduced to within local reference ranges for all cases after CPAP treatment.
Figure 3.
Figure 3.
Mean difference (MD) in noradrenaline levels calculated as post-CPAP treatment adrenaline levels minus pre-CPAP treatment adrenaline levels (A), and percentage change (PC) in noradrenaline levels calculated as (post-CPAP treatment adrenaline levels minus pre-CPAP treatment adrenaline levels)/pre-CPAP treatment adrenaline levels (B) for individual cases (●) and for pooled results (♦).
Figure 4.
Figure 4.
Risk of bias summary for included reports evaluated by the ROBINS-I tool.
See this image and copyright information in PMC

References

    1. Widmaier EP, Raff H, Strang KT. Vander's human physiology. New York, NY: McGraw-Hill; 2006.
    1. Lenders JW, Eisenhofer G, Mannelli M, et al.. Phaeochromocytoma. Lancet 2005; 366: 665–675. - PubMed
    1. Kudva YC, Sawka AM, Young WF., Jr. The laboratory diagnosis of adrenal pheochromocytoma: the Mayo clinic experience. J Clin Endocrinol Metab 2003; 88: 4533–4539. - PubMed
    1. Kales A, Cadieux R, Shaw IIL, et al.. Sleep apnoea in a hypertensive population. Lancet 1984; 324: 1005–1008. - PubMed
    1. Williams AJ, Houston D, Finberg S, et al.. Sleep apnea syndrome and essential hypertension. Am J Cardiol 1985; 55: 1019–1022. - PubMed