From the Guidelines
Anti-aldosterone medications, such as spironolactone and eplerenone, should not be used as primary treatments for obstructive sleep apnea (OSA) due to the lack of strong evidence supporting their effectiveness in this context. The most recent and highest quality study, 1, suggests that pharmacologic agents, including anti-aldosterone medications, have limited evidence to support their use in OSA management.
Key Considerations
- The American College of Physicians guideline, 1, recommends against the use of pharmacologic therapy, including anti-aldosterone medications, as a primary treatment for OSA due to insufficient evidence.
- The study, 1, categorizes drugs into four categories, including those that may worsen OSA, are unlikely to have an impact, have scarce or contradictory data, and those with a possible positive effect, but does not provide strong evidence to support the use of anti-aldosterone medications in OSA management.
- Another study, 1, also emphasizes the lack of evidence to support the use of pharmacologic treatments, including anti-aldosterone medications, as a primary therapy for OSA.
Clinical Implications
- Primary OSA treatments, such as CPAP, weight loss, and positional therapy, should be prioritized over anti-aldosterone medications.
- Anti-aldosterone medications may be considered as adjunctive therapy in patients with treatment-resistant OSA and concurrent conditions, such as heart failure or hypertension, but their use should be carefully monitored and weighed against potential risks and benefits.
- Clinicians should be cautious when prescribing anti-aldosterone medications for OSA management and consider the potential for adverse effects, such as hyperkalemia, gynecomastia, and hypotension.
From the Research
Anti-Aldosterone Medicines in Obstructive Sleep Apnea (OSA)
- The use of anti-aldosterone medicines, such as spironolactone, has been studied in the context of OSA, particularly in patients with resistant hypertension 2, 3.
- Studies have shown that spironolactone can reduce the severity of OSA, as measured by the apnea-hypopnea index (AHI), and improve blood pressure control in patients with resistant hypertension 2, 3.
- The mechanism by which spironolactone improves OSA severity is thought to be related to its ability to reduce aldosterone-mediated chronic fluid retention, which can contribute to upper airway obstruction during sleep 2.
Clinical Implications
- The American Heart Association recommends screening for OSA in patients with resistant or poorly controlled hypertension, as well as in those with pulmonary hypertension, recurrent atrial fibrillation, and heart failure 4.
- Treatment of OSA typically involves the use of continuous positive airway pressure (CPAP) therapy, as well as lifestyle modifications such as weight loss and behavioral changes 4, 5.
- Anti-aldosterone medicines, such as spironolactone, may be considered as an adjunctive treatment for OSA in patients with resistant hypertension, although further studies are needed to confirm their efficacy and safety in this population 2, 3.
Current Research
- A systematic review and meta-analysis of randomized controlled trials found that CPAP therapy can improve blood pressure control in patients with OSA and resistant hypertension, particularly during nighttime hours 6.
- Further research is needed to fully understand the relationship between OSA, hypertension, and anti-aldosterone medicines, and to determine the optimal treatment strategies for patients with these conditions 2, 3, 6.