Risk factors associated with hypertension in patients attending a pediatric sleep clinic: a prospective cohort study

Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension due to an interplay of factors. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH). However, ABPM is not routinely performed. We aim to detect hypertension using ABPM and to identify risk factors associated with hypertension. This was a prospective cohort study of pediatric patients (5-18 years of age) who had been referred to the sleep clinic. Polysomnography (PSG) or overnight pulse oximetry (OPO) were performed as per standard of care. ABPM was performed for all recruited patients. The primary outcome was hypertension, i.e., ambulatory hypertension or MH. Sixty-eight patients were recruited. Median age was 12.6 (interquartile range [IQR] 10.0-14.7) years. Fourteen (21%) did not return for the ABPM and ten (15%) had insufficient readings. Of the remaining 44 patients with complete ABPM data, hypertension was diagnosed in 18/44 (41%) with 10 (23%) having ambulatory hypertension and 8 (18%) having MH. Among the 18 patients with hypertension, one defaulted sleep study; 3/17 (18%) had primary snoring; 6/17 (35%), 4/17 (24%), and 4/17 (24%) had mild, moderate, and severe OSA, respectively. The prevalence of hypertension was 6/20 (30%), 4/10 (40%), 4/8 (50%), and 3/5 (60%) among patients with mild, moderate, and severe OSA and primary snoring, respectively. Age (relative risk [RR] 1.27, 95% confidence interval [CI] 1.07-1.52, p = 0.008) and primary snoring (RR 3.52, 95% CI 1.38-8.97, p = 0.004) were independently associated with hypertension.

Increasing age and primary snoring may be independently associated with hypertension among pediatric patients attending the sleep clinic. Larger studies will be required to validate these risk factors.

• Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension which is often due to an interplay of multiple factors. • Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH).

• In this prospective single-center study, ABPM was performed for all patients, classifying hypertension based on the 2022 update on ABPM in children from the American Heart Association. • Increasing age and primary snoring were independently associated with hypertension in pediatric patients attending the sleep clinic.