Poor Sleep and Cardiovascular Function in Children

Abstract

Abstract-We investigated whether sleep quantity and quality were related to 24-hour ambulatory blood pressure and cardiovascular reactivity in children. We studied term-born, healthy 8.0-year olds (SD: 1.4 years) without sleepdisordered breathing (231 and 265 children provided valid data for analyses of ambulatory blood pressure and cardiovascular reactivity, respectively). Sleep was registered with an actigraph for 6 nights on average (SD: 1.2; range: 3 to 13 nights). Ambulatory blood pressure was measured for 24-hours (41% nonschool days) with an oscillometric device. The children underwent the Trier Social Stress Test for Children, during which blood pressure, electrocardiography, and thoracic impedance were recorded and processed offline to give measures of cardiovascular and autonomic function. Neither quantity nor quality of sleep was related to 24-hour ambulatory blood pressure or cardiovascular reactivity after accounting for major covariates (sex, age, height, body mass index, and parental education). Although lower sympathetic nervous system activation and higher cardiac activation under stress were found in the group of children who slept for short duration when they were compared with the average sleep duration group, these associations were not significant after correction for multiple testing and were not seen in linear regression models of the effects of sleep duration. 3,4 are established in adults but not in children. This is surprising given that Յ40% of all children are estimated to experience sleep problems and that the problem persists in approximately half of those affected. 5 Furthermore, elevated blood pressure (BP) and hypertension in pediatric populations are more commonly recognized than in the past. 6 BP tracks over time from childhood to adulthood, 7 and longitudinal data show that elevated BP levels in childhood are associated with hypertension, 8 manifestations of carotid atherosclerosis, 9 and coronary heart disease 10 in adulthood.Few existing studies have addressed associations between poor sleep and cardiovascular function in children. Those that have differ in their target populations and their measures of sleep and have produced contradictory results. For example, actigraphic and polysomnographic measures of low sleep efficiency (percentage of time in bed spent asleep) were associated with elevated systolic and diastolic BPs, as well as hypertension in a multiethnic sample of 13-to 16-year olds from the United States. 11 Others have relied on parent or teacher reports to assess sleep duration indirectly. In these studies, longer sleep has been associated variously with increased BP, 12 decreased BP, 13 and no change in BP 14 in groups that differed by age and ethnicity, with sample sizes ranging from 117 12 to 12 680. 13 In many of these studies, measures of resting cardiovascular function have been limited to occasional BP measurements, and we are not aware of any such studies addressing cardiovascular function in response to a challenge. This may be important, given the ab...

Oral Health Status of Children With High Risk of Sleep-Disordered Breathing

“…3,4 OSA has a serious effect on the growth and development of a child; if untreated, OSA may lead to significant morbidity including vascular and metabolic disorders and neurocognitive dysfunction, ultimately leading to reduced quality of life and increased medical expenses. 5,6 Oral diseases are major public health issues as a result of considerable function impairment, reduced quality of life, and the costly treatment. 7 Cumulative evidence supports a link between systemic diseases or health complications and oral diseases.…”

Acute and Chronic Effects of Sleep Duration on Blood Pressure

“…[6][7][8][9][10][11][12][13][14][15] The reported results, however, are conflicting and inconsistent (Supplemental Table 5). Most studies did not control for the confounding effects of obesity and obstructive sleep apnea (OSA).…”

“…Some studies documented the usual sleep duration in typical weekdays in recent months [6][7][8] or without specified time frame, 9-11 whereas others measured sleep duration several days before the day of BP measurement 12,13 or recorded sleep duration and BP concurrently within the same time frame 14,15 (Supplemental Table 5). …”

“…Most published studies were limited by the use of a single question to assess sleep duration, 6,7,9-11 use of spot BP measurements, [6][7][8][9][10][11][12][13] and failure to control for OSA. 6,7,[9][10][11][12]14,15 OSA has been documented to lead to elevated BP in children and adolescents. [18][19][20][21] Therefore, in assessing the relationship between sleep duration and BP, the OSA status has to be ascertained and controlled for.…”

“…Most of the previous studies included both obese and nonobese subjects and analyzed the 2 groups together. 6,7,[9][10][11][12][13][14][15] Obesity is associated not only with BP levels but also with sleep duration and severity of sleepdisordered breathing. It could be difficult to eliminate its confounding effect simply by statistical means.…”