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Implementation of a formal sleep center-based screening protocol for primary aldosteronism in patients with obstructive sleep apnea

Wright, Kyla; Mahmoudi, Mandana; Agrawal, Nidhi; Simpson, Hope; Lui, Michael S; Pachter, H Leon; Patel, Kepal; Prescott, Jason; Suh, Insoo
BACKGROUND:There is a bidirectional association between primary aldosteronism and obstructive sleep apnea, with evidence suggesting that the treatment of primary aldosteronism can reduce obstructive sleep apnea severity. Current guidelines recommend screening for primary aldosteronism in patients with comorbid hypertension and obstructive sleep apnea, identifying potential candidates for treatment. However, emerging data suggest current screening practices are unsatisfactory. Moreover, data regarding the true incidence of primary aldosteronism among this population are limited. This study aimed to assess the primary aldosteronism screening rate among patients with obstructive sleep apnea and hypertension at our institution and estimate the prevalence of primary aldosteronism among this population. METHODS:Sleep studies conducted at our institution between January and September 2021 were retrospectively reviewed. Adult patients with a sleep study diagnostic of obstructive sleep apnea (respiratory disturbance index ≥5) and a diagnosis of hypertension were included. Patient medical records were reviewed and laboratory data of those with biochemical screening for primary aldosteronism were assessed by an experienced endocrinologist. Screening rates were compared before and after initiation of a screening protocol in accordance with the 2016 Endocrine Society guidelines. RESULTS:A total of 1,005 patients undergoing sleep studies were reviewed; 354 patients had comorbid obstructive sleep apnea and hypertension. Patients were predominantly male (67%), with a mean age of 58 years (standard deviation = 12.9) and mean body mass index of 34 (standard deviation = 8.1). The screening rate for primary aldosteronism among included patients was 19% (n = 67). The screening rate was significantly higher after initiation of a dedicated primary aldosteronism screening protocol (23% vs 12% prior; P = .01). Fourteen screens (21%) were positive for primary aldosteronism, whereas 45 (67%) were negative and 8 (12%) were indeterminate. Four had prior abdominal cross-sectional imaging, with 3 revealing an adrenal adenoma. Compared with patients without primary aldosteronism, patients with positive primary aldosteronism screens were more likely to have a history of hypokalemia (36% vs 4.4%; P = .002). The frequency of hyperlipidemia, diabetes mellitus, and left ventricular hypertrophy did not differ between patients with positive versus negative screens. CONCLUSION/CONCLUSIONS:Current screening practices for primary aldosteronism among patients with comorbid obstructive sleep apnea and hypertension are suboptimal. Patients evaluated at sleep centers may represent an optimal population for screening, as the prevalence of primary aldosteronism among this cohort appears high.
PMID: 36198493
ISSN: 1532-7361
CID: 5361722


Magda, G; Mahmoudi, M; Sterman, D
SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30
ISSN: 1931-3543
CID: 4119212

A Case of Recurrent Hypersomnia With Autonomic Dysfunction

Mahmoudi, Mandana; Friedman, Daniel; Vendrame, Martina; Kothare, Sanjeev V
ABSTRACT: We report the case of a 50-year-old man with disabling recurrent hypersomnia with autonomic instability due to catatonia in the setting of atypical bipolar disorder. Treatment with valproic acid for bipolar disorder resulted in complete resolution of symptoms.
PMID: 28633719
ISSN: 1550-9397
CID: 2639742

A Case of Recurrent Insomnia: Extending the Spectrum of Autoimmune Encephalitis

Sabharwal, Priyanka; Mahmoudi, Mandana; Berberi, Nisida; Vasquez, Blanca A; Friedman, Daniel; Kothare, Sanjeev V
ABSTRACT: Recurrent insomnia is an uncommon manifestation that is encountered rarely in a sleep clinic. We report a woman with recurrent insomnia due to an autoimmune process that resolved after a course of immunotherapy.
PMID: 26943714
ISSN: 1550-9397
CID: 2046402

Amiodarone: A Cryptic Culprit For Cirrhosis Associated Respiratory Failure [Meeting Abstract]

Awan, O; Mahmoudi, M; Basavaraj, A; Rajmane, R
ISSN: 1535-4970
CID: 2414502

A Rare Cause Of Extrapulmonary Respiratory Failure [Meeting Abstract]

Mahmoudi, M; Wu, BG; Ahmed, N; Katzman, D; Chitkara, N; Leibert, E; Zamuco, R; Addrizzo-Harris, D
ISSN: 1535-4970
CID: 2215022

Restless legs syndrome

Chapter by: Mahmoudi, M; Kothare, SV
in: Sleep Disorders in Adolescents: A Clinical Casebook by
pp. 27-44
ISBN: 9783319417424
CID: 2687032

Scedosporium - A Master Of Disguise [Meeting Abstract]

Mahmoudi, M; Sternschein, RM; Addrizzo-Harris, DJ
ISSN: 1535-4970
CID: 2162042

Iatrogenic Manganism: Acute Manganese Toxicity With Involvement Of The Globus Pallidus [Meeting Abstract]

Murthy, V; Mahmoudi, M; Basavaraj, A; Mendelson, J; Weisstuch, J; Schwartz, DR
ISSN: 1535-4970
CID: 2161902

Despite Negative Acid-Fast-Bacilli Maintain Suspicion For Tuberculosis If Clinically Indicated [Meeting Abstract]

Brosnahan, SB; Mahmoudi, M; Condos, R
ISSN: 1535-4970
CID: 2161722