Childhood sleep apnea associated with adolescent hypertension: Study

Although pediatric guidelines have delineated updated thresholds for elevated blood pressure (eBP) in youth and adult guidelines have recognized obstructive sleep apnea (OSA) as an established risk factor for elevated blood pressure (eBP), the relative association of pediatric Obstructive Sleep Apnea (OSA)with adolescent eBP remains unexplored.

A group of researchers conducted a study to assess the association of pediatric Obstructive Sleep Apnea (OSA) with elevated blood pressure (eBP) and its orthostatic reactivity in adolescence.

At baseline of this population-based cohort study (Penn State Child Cohort) in 2000-2005, a random sample of 700 children aged 5 to 12 years from the general population was studied. A total of 421 participants (60.1%) were followed up in 2010-2013 after 7.4 years as adolescents (ages, 12-23 years). Data analyses were conducted from July 6 to October 29, 2020.

Outcomes were the apnea-hypopnea index (AHI) score, ascertained via polysomnography conducted in a laboratory; elevated blood pressure (eBP) measured in the seated position identified using guideline-recommended pediatric criteria; orthostatic hyperreactivity identified with BP assessed in the supine and standing positions; and visceral adipose tissue assessed via dual-energy x-ray absorptiometry.

The results of the study are as follows:

• Among the 421 participants were racial/ethnic minorities.
• A persistent AHI of 2 or more since childhood was longitudinally associated with adolescent elevated blood pressure (eBP) while a remitted AHI of 2 or more was not.
  
• Adolescent OSA was associated with elevated blood pressure (eBP) in a dose-response manner; however, the association of an AHI of 2 to less than 5 among adolescents was nonsignificant and that of an AHI of 5 or more was approximately 2-fold after adjusting for visceral adipose tissue.
  
• An AHI of 5 or more but not between 2 and less than 5, was associated with orthostatic hyperreactivity among adolescents even after adjusting for visceral adipose tissue.
• Childhood Obstructive Sleep Apnea (OSA) was not associated with adolescent elevated blood pressure (eBP) in female participants, while the risk of OSA and elevated blood pressure (eBP) was greater in male participants.
  

Thus, the researchers concluded that the results of this cohort study suggest that childhood OSA is associated with adolescent hypertension only if it persists during this developmental period. Visceral adiposity explains a large extent of, but not all, the risk of hypertension associated with adolescent Obstructive Sleep Apnea (OSA), which is greater in male individuals.

Reference:

Association of Pediatric Obstructive Sleep Apnea With Elevated Blood Pressure and Orthostatic Hypertension in Adolescence by Julio Fernandez-Mendoza et. al published in the JAMA Cardiol.

doi:10.1001/jamacardio.2021.2003