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If the difference between the two readings of SBP or DBP was more than 5 mmHg, it should be measured again and the average of the three readings should be recorded. Studies have suggested that the co-morbidity of OSAHS and PA can mutually affect and exacerbate each other (9, 10). Aldosterone excess could also damage the taste sensitivity of sodium chloride and promote increased salt intake, further facilitating water-sodium retention (23). Additionally, it has been demonstrated that OSAHS severity was strongly correlated with an overnight reduction of leg fluid volume and calf circumference (24).
3 Screening and confirmatory tests
Those confirmed by AVS with bilateral or unilateral excessive secretion of aldosterone were diagnosed with primary aldosteronism (PA). However, it should be acknowledged that this diagnostic criterion carries some degree of scientific uncertainty. The AVS examination is typically used for subtype classification rather than confirming the diagnosis of PA itself.
4 The diagnosis value of PAC and ARR at screening for PA according to the degree of OSAHS
Recently, there has been a shift towards naming conditions descriptively (by symptoms or underlying cause) rather than eponymously, but the eponymous syndrome names often persist in common usage. The PAC and the PRA were evaluated after SIT and CCT in both groups (Table 2). In SIT, patients in the OSAHS-PA group exhibited significantly higher levels of PAC and PRA at both at immediately after the start of the infusion and 4 h compared to patients in the OSAHS-no PA group. In CCT, there was no significant difference in PAC at 0 h between patients in the OSAHS-PA group and those in the OSAHS-no PA group. However, at 2 h, patients in the OSAHS-PA group had significantly higher PAC levels compared to those in the OSAHS-no PA group, and the PAC suppression percentage was significantly lower in the OSAHS-PA group compared to the OSAHS-no PA group.
3 The diagnosis value of PA among different indicators by ROC graph curves
This study contributes to existing knowledge by advocating for the nuanced application of ARR in screening practices, especially in settings where PA is prevalent among patients with OSAHS and RH. It is important to emphasize, however, that these indicators serve as preliminary aids and should not replace the confirmatory tests in PA diagnosis. The ROC curves of PAC and ARR at screening for the prediction of PA in (A,B) patients with severe OSAHS, and (C,D) patients with moderate OSAHS. PAC, plasma aldosterone concentration; ARR, plasma aldosterone-renin ratio; ROC, receiver operating characteristic; PA, primary aldosteronism; OSAHS, obstructive sleep apnea hypopnea syndrome. This study investigated the diagnostic value of common screening indicators, including PRA, PAC, and ARR, for identifying PA among patients with moderate and severe OSAHS combined with RH.
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OSAHS-induced intermittent hypoxia leads to increased sympathetic activity, resulting in activation of the renin-angiotensin-aldosterone system (RAAS), which increases the risk of hypertension (3). Primary aldosteronism (PA) is a disorder in which the zona glomerulosa of the adrenal cortex abnormally secretes aldosterone hormone, resulting in elevated plasma aldosterone concentrations and decreased plasma renin activity. PA is considered a common cause of secondary RH (6), the prevalence of which ranges from 3% to 13% in the overall population (7, 8).
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Notably, in the subgroup of patients with severe OSAHS, the screening efficacy of PAC and ARR was particularly significant. Early identification of PA using these indicators can lead to prompt intervention and improve patient outcomes. While these indicators can streamline the initial assessment process in patients at higher risk of PA and potentially reduce costs, the definitive diagnosis should rely on more conclusive tests. ARR, plasma aldosterone-renin ratio; AVS, adrenal venous sampling; CCT, captopril challenge test; COPD, chronic obstructive pulmonary disease; MRA, mineralocorticoid receptor agonist; OSA, obstructive sleep apnea; PA, primary aldosteronism; SIT, saline infusion test.
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It's a common experience among designers, but one that you can overcome with the right mindset and strategies. Remember, you're not alone in this, and with some effort, you can reinforce your design confidence and continue to grow professionally. Predictive value of PAC at screening and ARR at screening for the diagnosis of PA according to OSAHS. Predictive value of PAC and ARR at screening for the diagnosis of PA. Look back at where you started, the challenges you've overcome, and the growth you've experienced.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common sleep respiratory disorder characterized by apnea, intermittent hypoxia, and sleep fragmentation due to recurrent partial or total collapse of the upper airway during sleep (1). The population prevalence of OSAHS ranges from 9% to 38% (2), and its diagnosis relies mainly on polysomnography. On one hand, excessive aldosterone secretion in patients with PA leads to water and sodium retention, causing edema of pharyngeal wall tissues and aggravating the severity of OSAHS (13). On the other hand, intermittent nocturnal hypoxia in patients with OSAHS may increase the activity of RAAS, which may lead to the occurrence and development of PA (9).
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