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24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea
Kun-Tai Kang1,2,3, Shuenn-Nan Chiu4, Wen-Chin Weng4,5
1Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Children with obstructive sleep apnea (OSA) show increased blood pressure (BP) and BP variability. Severe OSA is linked to higher nighttime BP and greater BP variability, independent of other factors.
Area of Science:
- Pediatric Pulmonology
- Cardiology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is a common condition in children.
- Elevated blood pressure (BP) and BP variability are risk factors for cardiovascular disease.
- The relationship between OSA severity and BP variability in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate blood pressure (BP) variability using 24-hour ambulatory BP monitoring in children diagnosed with obstructive sleep apnea (OSA).
Main Methods:
- A case series study involving 550 children aged 4 to 16 years with clinical symptoms suggestive of OSA.
- Overnight polysomnography was conducted to classify OSA severity (primary snoring, mild, moderate, severe).
- 24-hour ambulatory BP monitoring was performed, with BP variability assessed by the standard deviation of mean BP.
Main Results:
- Children with severe OSA exhibited significantly higher nighttime systolic BP, diastolic BP, mean arterial pressure, and BP loads compared to those with primary snoring.
- Nighttime systolic BP variability was significantly higher in children with severe OSA (11.4 vs. 9.6, P=.001).
- Multiple linear regression confirmed an independent association between the apnea-hypopnea index (AHI) and nighttime systolic BP variability (regression coefficient=0.31, P=.015).
Conclusions:
- Obstructive sleep apnea (OSA) in children is associated with increased blood pressure (BP) and heightened BP variability.
- The findings highlight the cardiovascular implications of OSA in pediatric patients.
- Monitoring BP variability in children with OSA is crucial for risk assessment.
Objective:
To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA).
Study Design:
Case series study.
Methods:
Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability.
Results:
A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status.
Conclusions:
OSA in children is associated with increased BP and BP variability.
Level Of Evidence:
4 Laryngoscope, 131:2126-2132, 2021.
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