Severe obstructive sleep apnea in children with elevated blood pressure

The objective was to determine the prevalence of habitual snoring and obstructive sleep apnea (OSA) in a cohort of children referred for elevated blood pressure (BP), and to determine the association between OSA and BP elevation, learning difficulties, and behavioral problems. We performed a retrospective review of 446 consecutive new patients referred for elevated BP. One hundred four (23%) had habitual snoring. Patients with habitual snoring were more likely to be obese (86.5 vs. 55.6%, P < .001) and to have Medicaid insurance (52.4 vs. 36%, P = .004). Seventy-four patients had polysomnography, of which 57 (77%) had OSA; 21 (37%) had severe OSA. Severe OSA was associated with higher office systolic BP index after adjusting for body mass index, age, sex, and socioeconomic status (β = 0.07, P = .014). Fifty-two percent of patients with severe OSA had office systolic BP in the Stage 2 hypertension range. Children with habitual snoring or OSA were not at increased risk of receiving school services for a learning disability or receiving medications for inattention or mood problems. In summary, habitual snoring is common in children referred for elevated BP, and those with severe OSA are at higher risk of significantly increased BP.