原发性醛固酮增多症和肢端肥大症能否成为非肥胖阻塞性睡眠呼吸暂停综合征患者的病因因素？

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中文摘要

背景： 阻塞性睡眠呼吸暂停综合征（OSAS）与肥胖密切相关；然而，相当一部分患者并非肥胖，这提示可能存在潜在的内分泌病因。本研究旨在调查非肥胖OSAS患者中原发性醛固酮增多症（PA）和肢端肥大症的患病率，并评估常规筛查的必要性。方法：前瞻性评估了经多导睡眠监测诊断为OSAS的非肥胖个体，非肥胖定义为体重指数（BMI）<30 kg/m²。评估了临床特征、合并症、血浆醛固酮与肾素活性比值（ARR）以及胰岛素样生长因子-1（IGF-1）水平。ARR升高的患者接受了确证性盐水输注试验，并在有指征时进行肾上腺影像学检查。结果：在103例患者中，根据原始研究方案，20例（19.4%）存在PA的生化证据；而事后应用2025年内分泌学会筛查标准，则识别出29例（28.2%）具有筛查阳性/可能PA表型的患者。原发性醛固酮增多症患者中高血压比无原发性醛固酮增多症患者更常见（70.0% vs. 24.1%）。队列中3.9%检测到肾上腺腺瘤。所有患者的IGF-1水平均在年龄和性别校正的参考范围内，未发现肢端肥大症病例。结论：这些发现提示，在非肥胖OSAS患者中筛查原发性醛固酮增多症可能具有临床必要性，而肢端肥大症的常规筛查应保留给具有提示性临床特征的患者。

英文摘要

Obstructive sleep apnea syndrome (OSAS) is strongly associated with obesity; however, a substantial proportion of patients are non-obese, raising the possibility of underlying endocrine etiologies. This study aimed to investigate the prevalence of primary aldosteronism (PA) and acromegaly in non-obese patients with OSAS and to evaluate the necessity of routine screening. Non-obese individuals, defined as those with a body mass index (BMI) < 30 kg/m², who were diagnosed with OSAS by polysomnography were prospectively evaluated. Clinical characteristics, comorbidities, plasma aldosterone-to-renin activity ratio (ARR), and insulin-like growth factor-1 (IGF-1) levels were assessed. Patients with elevated ARR underwent confirmatory saline infusion testing and adrenal imaging when indicated. Among 103 patients, biochemical evidence of PA according to the original study protocol was identified in 20 patients (19.4%), whereas post hoc application of the 2025 Endocrine Society screening criteria identified 29 patients (28.2%) with a screen-positive/probable PA phenotype. Hypertension was more frequent in patients with primary aldosteronism than in those without primary aldosteronism (70.0% vs. 24.1%). Adrenal adenomas were detected in 3.9% of the cohort. IGF-1 levels were within age- and sex-adjusted reference ranges in all patients, and no cases of acromegaly were identified. These findings suggest that screening for primary aldosteronism may be clinically warranted in non-obese patients with OSAS, whereas routine screening for acromegaly should be reserved for those with suggestive clinical features.