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Nocturnal blood pressure patterns in pediatric obstructive sleep apnea: The Kids Trial study
Olga Mediano1, María Castillo-García1, Sofía Romero-Peralta1
1Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, 19002, Guadalajara, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029, Madrid, Spain; Instituto de Investigación Sanitaria Castilla La Mancha (IDISCAM), 45071, Toledo, Spain; Medicine Department, Universidad de Alcalá, 28805, Madrid, Spain.
Insights
Severe obstructive sleep apnea (OSA) in children disrupts nocturnal blood pressure (BP) regulation, leading to reduced BP dipping. Ambulatory BP monitoring is crucial for pediatric sleep evaluations.
Area of Science:
- Pediatric Cardiology
- Sleep Medicine
- Hypertension Research
Background:
- Obstructive sleep apnea (OSA) in children is linked to cardiovascular risks.
- The precise impact of OSA on nocturnal blood pressure (BP) patterns is not fully understood.
- Non-dipping pattern (NDP) is a marker of altered BP regulation.
Purpose of the Study:
- To investigate the association between OSA severity, measured by the obstructive apnea-hypopnea index (OAHI), and abnormal sleep BP patterns, specifically NDP.
- To utilize ambulatory 24-hour BP monitoring (ABPM) for assessing sleep BP in children with suspected OSA.
Main Methods:
- The study involved 267 children in a multicenter observational trial (Kids-Trial, NCT03696654) in Spain.
- Polysomnography was used to diagnose OSA.
- Multivariable logistic regression analyzed the impact of OAHI on NDP risk, calculating odds ratios (OR).
Main Results:
- Significant positive trends in various BP measures (24-h, sleep mean, systolic, diastolic) were observed with increasing OSA severity.
- Severe OSA was independently associated with a reduced drop in mean BP during sleep (p=0.026).
- An increased, though not statistically significant, risk of NDP was noted in severe OSA (OR=2.76).
Conclusions:
- Severe pediatric OSA is independently linked to disrupted nocturnal BP regulation, characterized by reduced BP dipping.
- These findings highlight the importance of incorporating ABPM into the evaluation of pediatric sleep disorders.
- Early identification and management of OSA may be critical for preventing cardiovascular complications.
Abstract:
Obstructive sleep apnea (OSA) in children is associated with cardiovascular risk, but its impact on sleep blood pressure (BP) remains incompletely understood.
Objective:
To assess the association between the severity of OSA, stratified by the obstructive apnea-hypopnea index (OAHI), and altered sleep BP patterns, specifically the non-dipping pattern (NDP), using ambulatory 24-h BP monitoring (ABPM).
Methods:
The Kids-Trial is a multicenter observational trial (NCT03696654) conducted in Spain, including children with suspected OSA that underwent polysomnography for its diagnosis. To estimate the impact of OAHI on the risk of NDP, a multivariable logistic regression model was constructed and odds ratio (OR) was calculated.
Results:
A total of 267 children were included (median age of 6 years and 42.7 % girls). When BP was assessed through z-score, significant positive trends were observed according to OSA severity in 24-h mean BP, 24-h systolic BP, sleep mean BP, sleep systolic BP, sleep diastolic BP, and NDP. A negative trend was observed for the drop in sleep mean BP. The adjusted model showed that severe OSA was independently associated with a reduced drop in mean BP (-3.68 (-6.9; -0.47); p = 0.026). Adjusted multivariable analysis of NDP showed an increased but not significant risk of NDP in severe OSA vs. non-OSA (OR = 2.76 (0.92, 8.30)).
Conclusion:
Severe pediatric OSA was independently associated with disrupted nocturnal BP regulation, including a reduced BP dipping. These findings underscore the importance of ABPM in pediatric sleep evaluations.
Clinical Trial Registration:
clinicaltrials.gov NCT03696654.
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