The relationship between sleep-disordered breathing, blood pressure, and urinary cortisol and catecholamines in
Deborah M Brooks1, Andrea Kelly2, John D Sorkin3
1Division of Child Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.
Insights
Children with obstructive sleep apnea (OSA) have higher blood pressure (BP) and altered BP patterns during sleep. OSA is linked to increased systolic hypertension prevalence in children.
Area of Science:
- Pediatric Sleep Medicine
- Cardiovascular Physiology
- Pediatric Hypertension
Background:
- Obstructive sleep apnea (OSA) is a known complication of hypertension in adults.
- The link between OSA and elevated blood pressure (BP) in children is suggested but not fully understood.
- Pathogenesis of OSA-related hypertension in pediatric populations requires further investigation.
Purpose of the Study:
- To investigate the impact of sleep and sleep apnea on blood pressure (BP) in children.
- To assess sympathetic nervous system activation via serum cortisol and urinary catecholamines in relation to OSA and BP.
- To test the hypothesis that children with OSA exhibit higher BP, urinary catecholamines, and cortisol levels compared to controls.
Main Methods:
- Blood pressure (BP) was measured during polysomnography in 78 children with suspected sleep-disordered breathing and 18 controls.
- BP monitoring occurred during wakefulness and at 30-60 minute intervals throughout sleep.
- 24-hour urinary collections for catecholamines and free cortisol were performed 48 hours prior to polysomnography.
Main Results:
- Blood pressure (BP) demonstrated variability across sleep stages, peaking during wakefulness and N1 sleep, and lowest during NREM stage 3.
- Children with high apnea-hypopnea index (AHI >5 events/h) showed a significantly higher prevalence of systolic hypertension (57%) compared to low-AHI snorers (22%) and controls (22%).
- High-AHI snorers exhibited elevated diastolic BP and blunted nocturnal diastolic BP changes during sleep compared to low-AHI snorers.
Conclusions:
- Pediatric blood pressure (BP) is influenced by sleep stage.
- Obstructive sleep apnea (OSA) in children is associated with systolic hypertension.
- OSA correlates with elevated diastolic BP and diminished BP regulation during sleep in children.
Study Objectives:
Hypertension is a complication of obstructive sleep apnea (OSA) syndrome in adults. A correlation between OSA syndrome and elevated blood pressure (BP) is suggested in children, but its pathogenesis remains unclear. Our aim was to study the effects of sleep and sleep apnea on BP and sympathetic nervous system activation as measured by serum cortisol and urinary catecholamines. We hypothesized that children with OSA syndrome would have higher BP, urinary catecholamines, and cortisol compared with controls.
Methods:
We measured BP during polysomnography in 78 children with suspected sleep-disordered breathing and 18 nonsnoring controls. BP was measured during wakefulness and every 30-60 minutes throughout the night. All participants had 24-hour urinary catecholamine and free cortisol collections 48 hours before polysomnography.
Results:
BP varied with sleep stage; it was highest during wakefulness and N1 and lowest during non-rapid eye movement stage 3. Children classified as high apnea-hypopnea index (AHI) snorers (AHI >5 events/h) had a greater prevalence of systolic hypertension (57%) than low-AHI snorers (22%) and nonsnoring controls (22%; P = .04). The high-AHI snorers also had higher diastolic BP (P < .02) as well as blunted nocturnal diastolic BP changes during sleep (P = .02) compared with low-AHI snorers (AHI <5 events/h). Twenty-hour urinary free cortisol and 24-hour urinary catecholamines were not associated with BP.
Conclusions:
BP in children varies with sleep stage. OSA is associated with systolic hypertension, higher BP during rapid eye movement sleep, as well as elevation of diastolic BP and blunted BP changes with sleep.
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