In patients with obstructive sleep apnea and resistant hypertension, which hormone is often elevated contributing to upper airway obstruction?

In patients with obstructive sleep apnea and resistant hypertension, which hormone is often elevated contributing to upper airway obstruction?

• A. Cortisol
• B. Aldosterone
• C. ADH
• D. Renin

Answer: (B)

Aldosterone is often elevated in patients with obstructive sleep apnea and resistant hypertension because it promotes sodium and water retention. This leads to fluid overload and, when lying down at night, a rostral fluid shift that pools around neck and pharyngeal tissues. The resulting edema narrows the upper airway and increases the propensity for obstruction during sleep, contributing to both OSA and harder-to-control blood pressure. This mechanism also explains why mineralocorticoid receptor antagonists like spironolactone or eplerenone can improve both BP and OSA symptoms in this setting. Cortisol can influence obesity and sleep apnea risk but does not directly cause nocturnal airway obstruction the way aldosterone-driven fluid shifts do. ADH mainly affects water balance rather than airway anatomy, and renin is upstream of aldosterone; in aldosterone excess, renin is typically low, so it’s not the primary driver of the obstruction.

Aldosterone is often elevated in patients with obstructive sleep apnea and resistant hypertension because it promotes sodium and water retention. This leads to fluid overload and, when lying down at night, a rostral fluid shift that pools around neck and pharyngeal tissues. The resulting edema narrows the upper airway and increases the propensity for obstruction during sleep, contributing to both OSA and harder-to-control blood pressure. This mechanism also explains why mineralocorticoid receptor antagonists like spironolactone or eplerenone can improve both BP and OSA symptoms in this setting.

Cortisol can influence obesity and sleep apnea risk but does not directly cause nocturnal airway obstruction the way aldosterone-driven fluid shifts do. ADH mainly affects water balance rather than airway anatomy, and renin is upstream of aldosterone; in aldosterone excess, renin is typically low, so it’s not the primary driver of the obstruction.