{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:50:12Z","timestamp":1790117412525,"version":"4.0.1"},"reference-count":109,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,10,16]],"date-time":"2022-10-16T00:00:00Z","timestamp":1665878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>This perspective paper used a grounded theory method to synthesize evidence proposing that sodium toxicity from excessive dietary salt intake is a potential common pathophysiological mechanism that mediates the association of hypertension, obstructive sleep apnea, and anxiety with cardiovascular disease and COVID-19. Increased anxiety in these conditions may be linked to a high-salt diet through stimulation of the sympathetic nervous system, which increases blood pressure while releasing catecholamines, causing a \u201cfight or flight\u201d response. A rostral shift of fluid overload from the lower to the upper body occurs in obstructive sleep apnea associated with COVID-19 and cardiovascular disease, and may be related to sodium and fluid retention triggered by hypertonic dehydration. Chronic activation of the renin-angiotensin-aldosterone system responds to salt-induced dehydration by increasing reabsorption of sodium and fluid, potentially exacerbating fluid overload. Anxiety may also be related to angiotensin II that stimulates the sympathetic nervous system to release catecholamines. More research is needed to investigate these proposed interrelated mechanisms mediated by dietary salt. Furthermore, dietary interventions should use a whole-food plant-based diet that eliminates foods processed with salt to test the effect of very low sodium intake levels on hypertension, anxiety, and obstructive sleep apnea in cardiovascular disease and COVID-19.<\/jats:p>","DOI":"10.3390\/diseases10040089","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T00:04:55Z","timestamp":1665965095000},"page":"89","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Hypertension, Anxiety and Obstructive Sleep Apnea in Cardiovascular Disease and COVID-19: Mediation by Dietary Salt"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-2274","authenticated-orcid":false,"given":"Ronald B.","family":"Brown","sequence":"first","affiliation":[{"name":"School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1161\/HYPERTENSIONAHA.119.14240","article-title":"High Blood Pressure and Cardiovascular Disease","volume":"75","author":"Fuchs","year":"2020","journal-title":"Hypertension"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2160","DOI":"10.1097\/MD.0000000000002160","article-title":"High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults","volume":"94","author":"Wu","year":"2015","journal-title":"Medicine"},{"key":"ref_3","first-page":"2897","article-title":"Regulation of arterial pressure: Role of pressure natriuresis and diuresis","volume":"45","author":"Hall","year":"1986","journal-title":"Fed. Proc."},{"key":"ref_4","unstructured":"Who.Int (2022, August 30). Salt Reduction. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/salt-reduction."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5049\/EBP.2015.13.1.7","article-title":"Salt Sensitivity and Hypertension: A Paradigm Shift from Kidney Malfunction to Vascular Endothelial Dysfunction","volume":"13","author":"Choi","year":"2015","journal-title":"Electrolytes Blood Press."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Grillo, A., Salvi, L., Coruzzi, P., Salvi, P., and Parati, G. (2019). Sodium intake and hypertension. Nutrients, 11.","DOI":"10.3390\/nu11091970"},{"key":"ref_7","unstructured":"Islam, M.S. (2017). Impact of Salt Intake on the Pathogenesis and Treatment of Hypertension. Hypertension: From Basic Research to Clinical Practice, Springer International Publishing."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2174\/1573402111666150530204136","article-title":"Mechanisms of Salt-Sensitive Hypertension","volume":"11","author":"Luzardo","year":"2015","journal-title":"Curr. Hypertens. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1056\/NEJMsb1607161","article-title":"Dietary Sodium and Cardiovascular Disease Risk\u2014Measurement Matters","volume":"375","author":"Cogswell","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e16973","DOI":"10.1097\/MD.0000000000016973","article-title":"Prevalence of and risk factors for anxiety after coronary heart disease: Systematic review and meta-analysis","volume":"98","author":"Chen","year":"2019","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/YCO.0000000000000217","article-title":"Anxiety as a risk factor in cardiovascular disease","volume":"29","author":"Allgulander","year":"2016","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/08870446.2020.1779273","article-title":"Anxiety as a risk factor for cardiovascular disease independent of depression: A prospective examination of community-dwelling men (the MrOS study)","volume":"36","author":"Karlsen","year":"2021","journal-title":"Psychol. Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"31","DOI":"10.31887\/DCNS.2018.20.1\/mdehert","article-title":"The intriguing relationship between coronary heart disease and mental disorders","volume":"20","author":"Detraux","year":"2018","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_14","unstructured":"Munir, S., Takov, V., and Coletti, V.A. (2022, October 07). Generalized Anxiety Disorder. StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441870\/."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"327","DOI":"10.31887\/DCNS.2015.17.3\/bbandelow","article-title":"Epidemiology of anxiety disorders in the 21st century","volume":"17","author":"Bandelow","year":"2015","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_16","unstructured":"Who.Int (2022, October 07). Cardiovascular Diseases (CVDs). Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2055102920987462","DOI":"10.1177\/2055102920987462","article-title":"Anxiety as a risk factor for cardiovascular disease independent of depression: A narrative review of current status and conflicting findings","volume":"8","author":"Karlsen","year":"2021","journal-title":"Health Psychol. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1161\/CIR.0000000000000988","article-title":"Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association","volume":"144","author":"Yeghiazarians","year":"2021","journal-title":"Circulation"},{"key":"ref_19","unstructured":"Slowik, J.M., Sankari, A., and Collen, J.F. (2022, October 07). Obstructive Sleep Apnea. StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459252\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","article-title":"Prevalence of obstructive sleep apnea in the general population: A systematic review","volume":"34","author":"Senaratna","year":"2017","journal-title":"Sleep Med. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"00034-2022","DOI":"10.1183\/23120541.00034-2022","article-title":"Is sleep disordered breathing a risk factor for COVID-19 or vice versa?","volume":"8","author":"Cardoso","year":"2022","journal-title":"ERJ Open Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"167","DOI":"10.33069\/cim.2021.0033","article-title":"Undiagnosed Obstructive Sleep Apnea and Acute COVID-19 Infection\u2014A Case Series","volume":"3","author":"Kang","year":"2021","journal-title":"Chronobiol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Iannella, G., Vicini, C., Lechien, J.R., Ravaglia, C., Poletti, V., di Cesare, S., Amicarelli, E., Gardelli, L., Grosso, C., and Patacca, A. (2021). Association Between Severity of COVID-19 Respiratory Disease and Risk of Obstructive Sleep Apnea. Ear Nose Throat J., 1455613211029783.","DOI":"10.1177\/01455613211029783"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2134241","DOI":"10.1001\/jamanetworkopen.2021.34241","article-title":"Association of Sleep-Related Hypoxia With Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System","volume":"4","author":"Wang","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_25","first-page":"95","article-title":"High-risk obstructive sleep apnea is related to longer hospital stay in COVID-19 patients","volume":"24","author":"Alkan","year":"2022","journal-title":"Eurasian J. Pulmonol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Hwang, D., Shi, J., Chen, A., Arguelles, J., Becker, K.A., Kim, J.B., Woodrum, R.R., Valentine, K., and Benjafield, A. (2021). Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes. Am. J. Respir. Crit. Care Med., A1108.","DOI":"10.1164\/ajrccm-conference.2021.203.1_MeetingAbstracts.A1108"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"884218","DOI":"10.3389\/fmed.2022.884218","article-title":"Impact of Obstructive Sleep Apnea (OSA) in COVID-19 Survivors, Symptoms Changes Between 4-Months and 1 Year After the COVID-19 Infection","volume":"9","author":"Labarca","year":"2022","journal-title":"Front. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1007\/s11325-021-02476-z","article-title":"Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19","volume":"26","author":"Voncken","year":"2022","journal-title":"Sleep Breath."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1007\/s11325-020-02203-0","article-title":"Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure","volume":"25","author":"Maas","year":"2021","journal-title":"Sleep Breath."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"zsab272","DOI":"10.1093\/sleep\/zsab272","article-title":"Obstructive sleep apnea is an independent risk factor for severe COVID-19: A population-based study","volume":"45","author":"Emilsson","year":"2022","journal-title":"Sleep"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101624","DOI":"10.1016\/j.smrv.2022.101624","article-title":"Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19: A quantitative meta-analysis based on adjusted effect estimates","volume":"63","author":"Hu","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1164\/rccm.202006-2252LE","article-title":"Sleep Apnea and COVID-19 Mortality and Hospitalization","volume":"202","author":"Cade","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e000845","DOI":"10.1136\/bmjresp-2020-000845","article-title":"Sleep apnoea is a risk factor for severe COVID-19","volume":"8","author":"Strausz","year":"2021","journal-title":"BMJ Open Respir. Res."},{"key":"ref_34","first-page":"24","article-title":"The prevalence of Obstructive Sleep Apnea (OSA) in patients recovering from COVID-19","volume":"7","author":"Schwarzl","year":"2021","journal-title":"ERJ Open Res."},{"key":"ref_35","unstructured":"WHO (2021). Hypertension and COVID-19: Scientific brief, 17 June 2021."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"665064","DOI":"10.3389\/fphys.2021.665064","article-title":"COVID-19 and Hypertension: The What, the Why, and the How","volume":"12","author":"Muhamad","year":"2021","journal-title":"Front. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1177\/00033197211053903","article-title":"Does COVID-19 Cause Hypertension?","volume":"73","author":"Akpek","year":"2022","journal-title":"Angiology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1161\/HYPERTENSIONAHA.122.19694","article-title":"Hypertension and Excess Risk for Severe COVID-19 Illness Despite Booster Vaccination","volume":"79","author":"Ebinger","year":"2022","journal-title":"Hypertension"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1136\/postgradmedj-2021-140674","article-title":"Hypertension as an independent risk factor for severity and mortality in patients with COVID-19: A retrospective study","volume":"98","author":"Chen","year":"2022","journal-title":"Postgrad. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1111\/jch.14417","article-title":"Mortality associated with COVID-19 and hypertension in sub-Saharan Africa. A systematic review and meta-analysis","volume":"24","author":"Bepouka","year":"2022","journal-title":"J. Clin. Hypertens."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20","DOI":"10.11606\/s1518-8787.2022056004311","article-title":"Systemic arterial hypertension as a risk factor for the severe form of covid-19: Scoping review","volume":"56","author":"Ribeiro","year":"2022","journal-title":"Rev. De Sa\u00fade P\u00fablica"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"5978314","DOI":"10.1155\/2022\/5978314","article-title":"Retrospective Study of Aging and Sex-Specific Risk Factors of COVID-19 with Hypertension in China","volume":"2022","author":"Wang","year":"2022","journal-title":"Cardiovasc. Ther."},{"key":"ref_43","first-page":"100285","article-title":"Hypertension and COVID-19: Updates from the era of vaccines and variants","volume":"27","author":"Swamy","year":"2022","journal-title":"J. Clin. Transl. Endocrinol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1161\/CIRCRESAHA.121.318054","article-title":"Hypertension, a Moving Target in COVID-19","volume":"128","author":"Savoia","year":"2021","journal-title":"Circ. Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1038\/s41371-020-00451-x","article-title":"COVID-19 and hypertension: Risks and management. A scientific statement on behalf of the British and Irish Hypertension Society","volume":"35","author":"Clark","year":"2021","journal-title":"J. Hum. Hypertens."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"639222","DOI":"10.3389\/fcvm.2021.639222","article-title":"Hypertension and COVID-19: Ongoing Controversies","volume":"8","author":"Tadic","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.numecd.2020.12.009","article-title":"Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis","volume":"31","author":"Du","year":"2021","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3779","DOI":"10.1038\/s41598-021-83295-w","article-title":"COVID-19 patients with hypertension are at potential risk of worsened organ injury","volume":"11","author":"Xia","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"684112","DOI":"10.3389\/fpubh.2021.684112","article-title":"Preexisting Mental Disorders Increase the Risk of COVID-19 Infection and Associated Mortality","volume":"9","author":"Wang","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1038\/s41440-022-00852-0","article-title":"Anxiety, home blood pressure monitoring, and cardiovascular events among older hypertension patients during the COVID-19 pandemic","volume":"45","author":"Zhang","year":"2022","journal-title":"Hypertens. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.bbi.2020.07.037","article-title":"Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors","volume":"89","author":"Mazza","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1097\/PSY.0000000000000934","article-title":"Prevalence and Risk Factors for Anxiety and Depression in Patients With COVID-19 in Wuhan, China","volume":"83","author":"Li","year":"2021","journal-title":"Psychosom. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"831189","DOI":"10.3389\/fpubh.2022.831189","article-title":"How Different Pre-existing Mental Disorders and Their Co-occurrence Affects COVID-19 Clinical Outcomes? A Real-World Data Study in the Southern United States","volume":"10","author":"Qiao","year":"2022","journal-title":"Front. Public Health"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S2215-0366(20)30462-4","article-title":"Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA","volume":"8","author":"Taquet","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e2134969","DOI":"10.1001\/jamanetworkopen.2021.34969","article-title":"Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020","volume":"4","author":"Teixeira","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1038\/s41398-021-01325-7","article-title":"Are psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable, and multivariable Mendelian Randomization study","volume":"11","author":"Luykx","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.jen.2020.02.011","article-title":"Salt Toxicity: A Systematic Review and Case Reports","volume":"46","author":"Metheny","year":"2020","journal-title":"J. Emerg. Nurs."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1007\/s00467-019-04387-4","article-title":"Is too much salt harmful? Yes","volume":"35","year":"2020","journal-title":"Pediatr. Nephrol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Brown, R.B. (2021). Sodium Toxicity in the Nutritional Epidemiology and Nutritional Immunology of COVID-19. Medicina, 57.","DOI":"10.3390\/medicina57080739"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1057\/ejis.2011.51","article-title":"Using grounded theory as a method for rigorously reviewing literature","volume":"22","author":"Wolfswinkel","year":"2013","journal-title":"Eur. J. Inf. Syst."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.jacc.2010.03.033","article-title":"Early-Onset Depression, Anxiety, and Risk of Subsequent Coronary Heart Disease: 37-Year Follow-Up of 49,321 Young Swedish Men","volume":"56","author":"Janszky","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jacc.2010.03.034","article-title":"Anxiety and risk of incident coronary heart disease: A meta-analysis","volume":"56","author":"Roest","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1192\/bjp.bp.114.156554","article-title":"Anxiety and new onset of cardiovascular disease: Critical review and meta-analysis","volume":"208","author":"Batelaan","year":"2016","journal-title":"Br. J. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"12436","DOI":"10.1038\/s41598-020-69427-8","article-title":"The association of chronic anxiousness with cardiovascular disease and mortality in the community: Results from the Gutenberg Health Study","volume":"10","author":"Reiner","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jacc.2010.04.013","article-title":"What does heart disease have to do with anxiety?","volume":"56","author":"Dimsdale","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1002\/da.20642","article-title":"Current perspectives of the roles of the central norepinephrine system in anxiety and depression","volume":"27","author":"Goddard","year":"2010","journal-title":"Depress. Anxiety"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1161\/HYPERTENSIONAHA.120.16186","article-title":"Activation of the Sympathetic Nervous System Promotes Blood Pressure Salt-Sensitivity in C57BL6\/J Mice","volume":"77","author":"Ralph","year":"2021","journal-title":"Hypertension"},{"key":"ref_68","first-page":"1121","article-title":"Association between anxiety and hypertension: A systematic review and meta-analysis of epidemiological studies","volume":"11","author":"Pan","year":"2015","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/0306-4530(93)90061-O","article-title":"Hypertonic saline infusion increases plasma norepinephrine concentrations in normal men","volume":"18","author":"Peskind","year":"1993","journal-title":"Psychoneuroendocrinology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1038\/npp.2010.2","article-title":"Changes in central sodium and not osmolarity or lactate induce panic-like responses in a model of panic disorder","volume":"35","author":"Molosh","year":"2010","journal-title":"Neuropsychopharmacology"},{"key":"ref_71","unstructured":"Arnold, E. (2022, August 30). Anxiety DSM-5 Diagnostic Criteria and Treatment Overview. Available online: https:\/\/pro.psycom.net\/assessment-diagnosis-adherence\/anxiety."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.trsl.2014.11.007","article-title":"Effects of dietary salt levels on monocytic cells and immune responses in healthy human subjects: A longitudinal study","volume":"166","author":"Yi","year":"2015","journal-title":"Transl. Res."},{"key":"ref_73","first-page":"256","article-title":"Fluid Redistribution in Sleep Apnea: Therapeutic Implications in Edematous States","volume":"4","author":"Kasai","year":"2017","journal-title":"Front. Med."},{"key":"ref_74","first-page":"e8241","article-title":"Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association","volume":"12","author":"Bangash","year":"2020","journal-title":"Cureus"},{"key":"ref_75","unstructured":"Dominguez, A., Muppidi, V., and Gupta, S. (2022, October 01). Hyperaldosteronism, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499983\/."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"R238","DOI":"10.1152\/ajpregu.00486.2014","article-title":"Mechanisms of brain renin angiotensin system-induced drinking and blood pressure: Importance of the subfornical organ","volume":"308","author":"Coble","year":"2015","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_77","unstructured":"Tiarks, G. (2022, September 01). Hypertonic dehydration: What Is It, Causes, Treatment, and More. Available online: https:\/\/www.osmosis.org\/answers\/hypertonic-dehydration."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/jvim.15454","article-title":"The renin-angiotensin-aldosterone system and its suppression","volume":"33","author":"Ames","year":"2019","journal-title":"J. Vet. Intern. Med."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"109738","DOI":"10.1016\/j.cbi.2021.109738","article-title":"Increased complications of COVID-19 in people with cardiovascular disease: Role of the renin\u2013angiotensin-aldosterone system (RAAS) dysregulation","volume":"351","author":"Augustine","year":"2022","journal-title":"Chem. Biol. Interact."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1038\/jhh.2011.47","article-title":"Resistant hypertension, obstructive sleep apnoea and aldosterone","volume":"26","author":"Dudenbostel","year":"2012","journal-title":"J. Hum. Hypertens."},{"key":"ref_81","first-page":"6","article-title":"Effect of excessive salt consumption on night\u2019s sleep","volume":"10","author":"Fereidoun","year":"2014","journal-title":"Pak J. physiol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1378\/chest.12-0802","article-title":"Increased dietary sodium is related to severity of obstructive sleep apnea in patients with resistant hypertension and hyperaldosteronism","volume":"143","author":"Pimenta","year":"2013","journal-title":"Chest"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"zsy016","DOI":"10.1093\/sleep\/zsy016","article-title":"Diuretic or sodium-restricted diet for obstructive sleep apnea\u2014A randomized trial","volume":"41","author":"Fiori","year":"2018","journal-title":"Sleep"},{"key":"ref_84","unstructured":"Oria, M., Harrison, M., and Stallings, V.A. (2019). The National Academies Collection: Reports funded by National Institutes of Health. Dietary Reference Intakes for Sodium and Potassium, National Academies Press (US)."},{"key":"ref_85","unstructured":"NHLBI (1996). Implementing Recommendations for Dietary Salt Reduction: Where Are We? Where Are We Going? How Do We Get There?: A Summary of an NHLBI Workshop."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1016\/j.jacc.2011.08.012","article-title":"Relationship between sodium intake and sleep apnea in patients with heart failure","volume":"58","author":"Kasai","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1001\/jamaoto.2019.2435","article-title":"Association of Obstructive Sleep Apnea With the Risk of Affective Disorders","volume":"145","author":"Kim","year":"2019","journal-title":"JAMA Otolaryngol. \u2013Head Neck Surg."},{"key":"ref_88","first-page":"205","article-title":"The correlation of anxiety and depression with obstructive sleep apnea syndrome","volume":"19","author":"Rezaeitalab","year":"2014","journal-title":"J. Res. Med. Sci."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"101282","DOI":"10.1016\/j.smrv.2020.101282","article-title":"Sleep in the anxiety-related disorders: A meta-analysis of subjective and objective research","volume":"51","author":"Cox","year":"2020","journal-title":"Sleep Med. Rev."},{"key":"ref_90","first-page":"e11203","article-title":"The Prevalence of Anxiety and Depression Symptoms in Obstructive Sleep Apnea","volume":"12","author":"Akberzie","year":"2020","journal-title":"Cureus"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"799792","DOI":"10.3389\/fmed.2022.799792","article-title":"Associations of Depression, Anxiety, and Life Events With the Risk of Obstructive Sleep Apnea Evaluated by Berlin Questionnaire","volume":"9","author":"Duan","year":"2022","journal-title":"Front. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ejcdt.2012.10.032","article-title":"Predictors of anxiety and depression in patients with obstructive sleep apnea","volume":"61","author":"Daabis","year":"2012","journal-title":"Egypt. J. Chest Dis. Tuberc."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1080\/15402002.2018.1545649","article-title":"Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis","volume":"18","author":"Garbarino","year":"2020","journal-title":"Behav. Sleep Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21037\/atm.2016.AB011","article-title":"AB011. Assessment of anxiety and depressive symptoms in obstructive sleep apnea patients","volume":"4","author":"Batzikosta","year":"2016","journal-title":"Ann. Transl. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"12631","DOI":"10.1038\/s41598-021-91996-5","article-title":"Stress in obstructive sleep apnea","volume":"11","author":"Wong","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1093\/sleep\/28.11.1405","article-title":"Association of psychiatric disorders and sleep apnea in a large cohort","volume":"28","author":"Sharafkhaneh","year":"2005","journal-title":"Sleep"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1007\/s11906-014-0476-2","article-title":"Chemoreflexes, sleep apnea, and sympathetic dysregulation","volume":"16","author":"Mansukhani","year":"2014","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1002\/emmm.201000080","article-title":"Angiotensin II revisited: New roles in inflammation, immunology and aging","volume":"2","author":"Benigni","year":"2010","journal-title":"EMBO Mol. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s10741-012-9368-1","article-title":"Angiotensin II, sympathetic nerve activity and chronic heart failure","volume":"19","author":"Wang","year":"2014","journal-title":"Heart Fail. Rev."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1161\/01.HYP.0000028001.65341.AA","article-title":"Angiotensin II induces catecholamine release by direct ganglionic excitation","volume":"40","author":"Dendorfer","year":"2002","journal-title":"Hypertension"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3389\/fneur.2012.00007","article-title":"Sympathetic and catecholaminergic alterations in sleep apnea with particular emphasis on children","volume":"3","author":"Hakim","year":"2012","journal-title":"Front. Neurol."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.sleep.2021.09.007","article-title":"Catecholamines and children obstructive sleep apnea: A systematic review","volume":"87","author":"Sica","year":"2021","journal-title":"Sleep Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/S0140-6736(22)00369-5","article-title":"Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): An international, open-label, randomised, controlled trial","volume":"399","author":"Ezekowitz","year":"2022","journal-title":"The Lancet"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Patel, Y., and Joseph, J. (2020). Sodium Intake and Heart Failure. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21249474"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1161\/CIRCULATIONAHA.116.024446","article-title":"Sources of Sodium in US Adults From 3 Geographic Regions","volume":"135","author":"Harnack","year":"2017","journal-title":"Circulation"},{"key":"ref_106","doi-asserted-by":"crossref","unstructured":"Brown, R.B. (2022). Low dietary sodium potentially mediates COVID-19 prevention associated with whole-food plant-based diets. Br. J. Nutr., 1\u20136.","DOI":"10.1017\/S0007114522002252"},{"key":"ref_107","unstructured":"cdc.gov (2022, October 06). How To Reduce Sodium Intake, Available online: https:\/\/www.cdc.gov\/salt\/reduce_sodium_tips.htm."},{"key":"ref_108","unstructured":"nhlbi.nih.gov (2022, October 06). DASH Eating Plan, Available online: https:\/\/www.nhlbi.nih.gov\/education\/dash-eating-plan."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1038\/s41581-021-00533-0","article-title":"The impact of excessive salt intake on human health","volume":"18","author":"Hunter","year":"2022","journal-title":"Nat. Rev. Nephrol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/4\/89\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:55:01Z","timestamp":1760144101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/10\/4\/89"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,16]]},"references-count":109,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["diseases10040089"],"URL":"https:\/\/doi.org\/10.3390\/diseases10040089","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,16]]}}}