Sleep quality in patients with primary aldosteronism

Area of Science:

• Endocrinology
• Sleep Medicine
• Cardiology

Background:

• Primary aldosteronism (PA) is frequently diagnosed in patients with sleep apnea (SA), and PA patients exhibit a high prevalence of SA.
• Current treatments for PA, including adrenalectomy (ADX) and mineralocorticoid receptor (MR) blockade, aim to reduce associated comorbidities.
• However, the impact of these treatments on sleep quality in PA patients remains uninvestigated.

Purpose of the Study:

• To investigate the effectiveness of primary aldosteronism treatments on sleep quality.
• To compare sleep quality between different PA treatment modalities.
• To identify potential differences in sleep quality based on patient demographics, such as sex.

Main Methods:

• A prospective multi-center study involving two cohorts of PA patients: newly diagnosed (n=15) and those treated long-term (n=81).
• Assessment included biochemical parameters, 24-hour blood pressure monitoring, and validated questionnaires: Giessen Complaint List (GBB-24), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI).
• Data were analyzed before and after treatment initiation, and at long-term follow-up, with comparisons based on treatment type and sex.

Main Results:

• Newly diagnosed PA patients showed a significant improvement in exhaustion tendency (GBB-24 Z-scores) after treatment initiation.
• In the long-term cohort, no significant differences in GBB-24, ESS, or PSQI scores were observed compared to baseline.
• Female patients reported significantly lower sleep quality (higher PSQI scores) than male patients, irrespective of the PA treatment received.

Conclusions:

• Initiation of PA treatment positively impacts exhaustion tendency in newly diagnosed patients.
• Long-term PA treatment did not show significant improvements in overall sleep quality or daytime sleepiness in the studied cohorts.
• Female PA patients experience more sleep disturbances than male PA patients, even after treatment, highlighting a potential sex-specific issue in sleep quality management for PA.