Prevalence and clinical correlates of positive aldosterone-torenin ratio screening in obese hypertensive patients with obstructive sleep apnea: a Southeast Asian crosssectional study

Abstract

Although routine screening for primary aldosteronism (PA) is increasingly recognized among patients with obstructive sleep apnea (OSA), data regarding aldosterone-to-renin ratio (ARR) screening positivity among Southeast Asian OSA populations remain limited, particularly in resource-limited settings. This study aimed to determine the prevalence and clinical correlates of ARR positivity screening among obese hypertensive OSA patients. In this cross-sectional study, obese hypertensive adults with confirmed OSA were recruited. Blood samples were analyzed for plasma aldosterone concentration (PAC), plasma renin concentration (PRC), serum potassium, and standard metabolic indices. Therapeutic intensity score (TIS) was used to quantify antihypertensive burden. ARR-based categories were applied to stratify patients into (i) positive ARR (Group 1), (ii) low renin/negative ARR (Group 2), or (iii) negative ARR (Group 3). Among 160 patients, 11.9% were classified in Group 1 and 20.0% as Group 2. Serum potassium levels were significantly lower in Group 2 compared with Group 3. An inverse association between PRC and uric acid was observed in the overall cohort, although the model fit was weak. In males, serum potassium, uric acid, and TIS were significantly associated with RAAS activity and were associated with greater likelihood for ARR positive screen. A substantial proportion of obese hypertensive OSA patients demonstrated ARR positivity. However, routine clinical and metabolic parameters alone were insufficient to reliably identify affected individuals. These findings support maintaining a low threshold for PA screening in hypertensive OSA patients.