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Hypoxic burden as a cause of cardiovascular morbidity in childhood obstructive sleep apnea

Plamen Bokov1, Benjamin Dudoignon1, Christophe Delclaux2

  • 1Paris Cité University, AP-HP, Robert Debré Hospital, Department of Physiology and Sleep Laboratory, INSERM NeuroDiderot, Paris, France.

Pediatric Research
|May 23, 2025
PubMed

Insights

Children with obstructive sleep apnea (OSA) and higher hypoxic burden (HB) show cardiac autonomic dysfunction and elevated blood pressure. This suggests HB is a key indicator of cardiovascular risk in pediatric OSA.

Area of Science:

  • Pediatric Cardiology
  • Sleep Medicine
  • Autonomic Nervous System Research

Background:

  • Obstructive sleep apnea (OSA) is common in children.
  • Cardiovascular complications are a concern in pediatric OSA.
  • The role of hypoxic burden (HB) in pediatric OSA cardiovascular health is unclear.

Purpose of the Study:

  • To investigate the association between hypoxic burden (HB) and cardiac autonomic nervous system (ANS) dysfunction.
  • To assess the relationship between HB and blood pressure (BP) in children with moderate to severe OSA.

Main Methods:

  • Matched case-control study of 20 pairs of children with moderate-to-severe OSA.
  • Groups were stratified by low (first quartile) versus high (fourth quartile) hypoxic burden (HB).
  • Cardiac autonomic function assessed using heart rate variability (HRV) indices; blood pressure (BP) measured via office readings.

Main Results:

  • Children with high HB exhibited signs of sympathetic overactivity and reduced parasympathetic modulation (decreased HRV indices SD1 and SD2).
  • The high HB group had significantly higher systolic and diastolic blood pressure percentiles compared to the low HB group, even after adjusting for obesity and arousal index.
  • These findings were observed despite similar obstructive apnea-hypopnea index (OAHI) levels between the groups.

Conclusions:

  • Higher hypoxic burden in pediatric OSA is linked to cardiac autonomic nervous system dysfunction.
  • Increased daytime blood pressure is associated with higher hypoxic burden in children with OSA.
  • Hypoxic burden emerges as a significant predictor of cardiovascular risk in childhood OSA.
Abstract

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