Twenty-four–hour Ambulatory Blood Pressure in Children with Sleep-disordered Breathing

Abstract

Obstructive sleep apnea causes intermittent elevation of systemic blood pressure (BP) during sleep. To determine whether obstructive apnea in children has a tonic effect on diurnal BP, 24-hour ambulatory blood pressure was obtained from 60 children with mean age of 10.8 Ϯ 3.5 years. Thirty-nine children had obstructive apnea and 21 had primary snoring. Children with obstructive apnea had significantly greater mean BP variability during wakefulness and sleep, a higher night-to-day systolic BP, and a smaller nocturnal dipping of mean BP. Variability of mean arterial pressure during wakefulness was predicted by the desaturation, body mass, and arousal indices, whereas variability during sleep was predicted by apnea-hypopnea and body mass indices. Nocturnal BP dipping was predicted by the desaturation index. There were no significant differences in systolic, diastolic, or mean arterial BP during sleep between the groups. Diastolic BP during wakefulness was significantly different between the groups and correlated negatively with apnea-hypopnea index. We conclude that obstructive apnea in children is associated with 24-hour BP dysregulation and that, independent of obesity, the frequency of obstructive apnea, oxygen desaturation, and arousal contributes to abnormal BP control.Obstructive sleep apnea (OSA) in adults increases the risk for heart failure, coronary artery disease, and stroke (1-3). The mechanisms underlying the link between OSA and cardiovascular diseases are not completely understood; however, systemic hypertension is thought to be one pathway leading to end-organ damage and cardiovascular morbidity (4-6). The early stages of abnormal blood pressure (BP) control may present with autonomic dysfunction in the form of increased sympathetic activity and/or decreased vagal tone. These autonomic changes alter the diurnal control and variability of BP (7). The adverse effect of abnormal BP control on the cardiovascular system is not only due to hypertension but also to earlier stages of abnormal BP control, such as increased BP variability and decreased nocturnal dipping (8-16). Because children with OSA, in comparison with children with primary snoring, are at greater risk for developing end-organ damage in the form of left ventricular hypertrophy (17), we hypothesized that children with OSA will demonstrate the earlier stages of abnormal BP control in the form of elevation

Sleep Apnea and Cardiovascular Disease

“…Ambulatory 24-hour BP recordings on 39 children with OSA and 21 with simple snoring showed increased BP variability during wakefulness and sleep and less nocturnal BP dipping in children with OSA compared with children with simple snoring. 382 In addition to BMI, the frequency of oxygen desaturation during sleep and AHI were significant predictors for daytime and nocturnal BP variability, respectively. However, compared with snoring children, those with OSA did not have higher daytime or nighttime BP.…”

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

“…These parameters include increases in both BP surge and BP load, as well as the previously described changes in BP variability and nocturnal BP dipping. 7 …”

“…We have previously demonstrated that in a group of children with SDB, the severity of the disorder was associated with increased BP variability and decreased nocturnal dipping. 7 Additionally, several cross-sectional studies have described trends of increasing BP with greater frequency of apnea and hypopneas index (AHI) during sleep. 8 -10 To date, however, the level of SDB severity at which BP in pediatric SDB patients begins to diverge from that of healthy controls is not known.…”

Bariatric surgery for pediatric extreme obesity: now or later?

“…Immediate consequences of OSAS are sleep fragmentation, arousal, poor school/job performance, irritability, intermittent hypercapnia and hypoxemia, nocturnal hypertension and marked changes in autonomic control of the cardiovascular system. 88 The long-term consequences of OSAS include sustained daytime and nocturnal hypertension, 89,90 cor pulmonale, left ventricular hypertrophy 91 and increased cardiovascular and cerebrovascular morbidity and mortality. 92 Indeed, cross-sectional results from the Sleep Heart Health Study showed a strong association between OSAS, heart failure and stroke.…”