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Published on: December 6, 2016
Obstructive sleep apnea and hypertension in pediatric chronic kidney disease
Anne Tsampalieros1, Henrietta Blinder2,3, Lynda Hoey4
1Department of Pediatrics, Division of Nephrology, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
Insights
This study found no obstructive sleep apnea (OSA) in children with mild to moderate chronic kidney disease (CKD). However, the obstructive apnea-hypopnea-index (OAHI) correlated with nighttime blood pressure in these pediatric patients.
Area of Science:
- Pediatric Nephrology
- Sleep Medicine
- Cardiology
Background:
- Children with chronic kidney disease (CKD) face increased risks for obstructive sleep apnea (OSA) and hypertension.
- Understanding the interplay between OSA, its symptoms, and hypertension is crucial for managing pediatric CKD patients.
Purpose of the Study:
- To investigate the associations between OSA severity (using apnea-hypopnea-index [AHI] and obstructive apnea-hypopnea-index [OAHI] from polysomnography [PSG]), OSA symptoms, and hypertension in children with CKD.
Main Methods:
- One-night in-laboratory polysomnography (PSG) and 24-h ambulatory blood pressure monitoring (ABPM) were conducted in children with CKD stages 2-5 (non-dialysis dependent).
- Sleep questionnaires, including the modified Epworth Sleepiness Scale (ESS) and the Pediatric Sleep Questionnaire (PSQ), were administered.
Main Results:
- No participants were diagnosed with OSA via PSG. The obstructive apnea-hypopnea-index (OAHI) showed a strong correlation with nighttime systolic and diastolic blood pressures (r=0.67 and r=0.69, respectively, p<0.05).
- The apnea-hypopnea-index (AHI) did not correlate with any blood pressure measures. Some participants reported positive scores on sleepiness and sleep disturbance questionnaires.
Conclusions:
- Obstructive sleep apnea (OSA) was not detected on PSG in children with predominantly mild to moderate chronic kidney disease (CKD).
- The obstructive apnea-hypopnea-index (OAHI) demonstrated a significant correlation with nighttime blood pressure levels.
- Further research with larger cohorts is warranted to track potential symptom progression and PSG findings in pediatric CKD patients across disease stages.
Background:
Children with chronic kidney disease (CKD) are at risk for obstructive sleep apnea (OSA) and hypertension. The objectives of this study were to explore associations between OSA severity using the apnea-hypopnea-index(AHI) and obstructive apnea-hypopnea-index(OAHI) on polysomnography (PSG), OSA symptoms, and measures of hypertension in children with CKD.
Methods:
One-night in-laboratory PSGs and 24-h ambulatory blood pressure monitoring (ABPM) were performed on children with CKD stages 2-5 (non-dialysis dependent). Sleep questionnaires, including the modified Epworth Sleepiness Scale (ESS) and the Pediatric Sleep Questionnaire (PSQ), were administered during the sleep study.
Results:
Nineteen children and adolescents completed a PSG and questionnaires and thirteen completed ABPMs. Mean (standard deviation) age at the time of the sleep study was 14.1 (3.2) years. Eleven (58%) participants had CKD stage two, and eight (42%) had stage 3-4. None of the participants were found to have OSA on PSG. One participant had a positive ESS score (≥ 11) and five participants had positive PSQ scores (≥ eight). Night systolic and diastolic pressures were strongly correlated with the OAHI (r = 0.67 and r = 0.69, respectively, p < 0.05), while the AHI was not correlated with any blood pressure measures.
Conclusions:
Our study did not find OSA on PSG in children with predominantly mild to moderate CKD. The OAHI was found to be strongly correlated with nighttime blood pressures. Future prospective studies with a larger sample size are needed to monitor for potential progression of symptoms and findings on PSG in pediatric patients as they evolve across the spectrum of CKD.
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