Effect of continuous positive airway pressure in hypertensive patients with obstructive sleep apnea and high urinary metanephrines

Luisa Gilardini, Carolina Lombardi, Gabriella Redaelli, Paola Mattaliano, Paolo Fanari, Mauro Cornacchia, Massimo Scacchi, Stefania Mai, Patrizia Ferronato, Gianfranco Parati, Cecilia Invitti

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. Methods: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6±8.7kg/m 2) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. Results: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26% and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r=0.799, P<0.0001) and minimal SaO 2 (r=-0.700, P<0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r=0.689, P<0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (β=0.738, P<0.01). Conclusion: Two-Thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.

Original languageEnglish
Pages (from-to)199-204
Number of pages6
JournalJournal of Hypertension
Volume36
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Normetanephrine
Metanephrine
Continuous Positive Airway Pressure
Obstructive Sleep Apnea
Ventilation
Apnea
Therapeutics
Endocrine System Diseases
Urine Specimen Collection
Substance-Related Disorders
Sleep
Reference Values
Multivariate Analysis

Keywords

  • continuous positive airway pressure therapy
  • obstructive sleep apnea
  • pheochromocytoma
  • urinary normetaneprhine

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

@article{d4b00d464a404b27814c317cf09d968d,
title = "Effect of continuous positive airway pressure in hypertensive patients with obstructive sleep apnea and high urinary metanephrines",
abstract = "Objective: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. Methods: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6±8.7kg/m 2) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. Results: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26{\%} and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r=0.799, P<0.0001) and minimal SaO 2 (r=-0.700, P<0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r=0.689, P<0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (β=0.738, P<0.01). Conclusion: Two-Thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.",
keywords = "continuous positive airway pressure therapy, obstructive sleep apnea, pheochromocytoma, urinary normetaneprhine",
author = "Luisa Gilardini and Carolina Lombardi and Gabriella Redaelli and Paola Mattaliano and Paolo Fanari and Mauro Cornacchia and Massimo Scacchi and Stefania Mai and Patrizia Ferronato and Gianfranco Parati and Cecilia Invitti",
year = "2018",
month = "1",
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language = "English",
volume = "36",
pages = "199--204",
journal = "Journal of Hypertension",
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TY - JOUR

T1 - Effect of continuous positive airway pressure in hypertensive patients with obstructive sleep apnea and high urinary metanephrines

AU - Gilardini, Luisa

AU - Lombardi, Carolina

AU - Redaelli, Gabriella

AU - Mattaliano, Paola

AU - Fanari, Paolo

AU - Cornacchia, Mauro

AU - Scacchi, Massimo

AU - Mai, Stefania

AU - Ferronato, Patrizia

AU - Parati, Gianfranco

AU - Invitti, Cecilia

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. Methods: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6±8.7kg/m 2) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. Results: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26% and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r=0.799, P<0.0001) and minimal SaO 2 (r=-0.700, P<0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r=0.689, P<0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (β=0.738, P<0.01). Conclusion: Two-Thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.

AB - Objective: Some cases of pseudopheochromocytoma have been described among hypertensive patients with obstructive sleep apnea (OSA). This study examined whether a pathological rise of urinary metanephrines is a common feature in hypertensive OSA patients and, in such a case, whether the ventilation treatment during sleep (continuous or biphasic positive airway pressure) may normalize high metanephrines levels. Methods: Patients with endocrine diseases, drug abuse, therapy with TCA and cardiovascular events in the previous 6 months were excluded. Thirty-four hypertensive patients with OSA (BMI 40.6±8.7kg/m 2) performed three 24-h urine collections for metanephrine assessment, before and after 1 month of ventilation therapy. Results: Urinary normetanephrine (uNMT) was above the normal limit in 21 of 34 of the patients. In the 16 to 21 patients with high uNMT who were compliant to ventilation treatment, uNMT decreased in 13 by 26% and normalized in six of 13. uNMT levels were associated with apnea hypopnea index (AHI) (r=0.799, P<0.0001) and minimal SaO 2 (r=-0.700, P<0.01). The ventilation therapy-induced changes in AHI were associated with those in uNMT (r=0.689, P<0.005). In the multivariate analysis with uNMT changes as dependent variable and changes in AHI, BMI, SBP as independent variables, only AHI changes were independently associated with uNMT changes (β=0.738, P<0.01). Conclusion: Two-Thirds of OSA hypertensive patients have uNMT values above the normal limit. The early identification of these patients is important as ventilation therapy can correct the pathological sympathoadrenal activation. Patients who do not normalize uNMT with ventilation therapy deserve a strict follow-up as this lack of normalization may indicate insufficient ventilation therapy or resistance of sympathetic hyperactivity to this treatment, not excluding an early stage of a chromaffin tumor.

KW - continuous positive airway pressure therapy

KW - obstructive sleep apnea

KW - pheochromocytoma

KW - urinary normetaneprhine

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