Severe Sleep Apnea Linked to Morning Hypertension in Children, Suggests Study
USA: Researchers have found in new research that severe obstructive sleep apnea (OSA) was independently associated with an increased risk of morning hypertension in children, regardless of obesity, sex, or developmental stage. The findings highlight the importance of routine blood pressure monitoring in children with OSA across all severity levels, particularly those with severe disease.
The study was published in Sleep Medicine by Rohan Bellary, University of Louisville School of Medicine, University of Louisville, Louisville, Kentucky, USA, and colleagues.
OSA is a common sleep disorder in children in which repeated interruptions of breathing during sleep can affect oxygen levels and cardiovascular function. The researchers sought to determine whether the severity of OSA was independently linked to elevated morning blood pressure and whether this relationship differed according to age or sex.
The study included 806 children aged 1–18 years, with 55.2% boys, who underwent overnight polysomnography and blood pressure assessment before and after the sleep study. Based on OAHI scores, participants were grouped as having normal/snoring, mild, moderate or severe OSA. Researchers assessed evening and morning blood pressure while adjusting for age, sex, BMI and comorbidities.
Key findings included:
- Morning systolic blood pressure increased progressively with OSA severity, rising from 108 ± 13 mmHg in children without OSA to 118 ± 15 mmHg in those with severe OSA.
- Children with severe OSA had more than twice the odds of morning hypertension after adjustment for potential confounding factors (OR 2.35; 95% CI 1.57–3.52).
- Each one-unit increase in the apnea-hypopnea index was associated with a 0.137 mmHg increase in morning systolic blood pressure after adjustment.
- The association between moderate OSA and blood pressure was weakened after accounting for BMI, suggesting that obesity may partly contribute to this relationship.
- BMI independently predicted blood pressure grade, with each increase in BMI z-score associated with higher odds of elevated blood pressure (OR 1.52; 95% CI 1.27–1.82).
- The relationship between OSA severity and systolic blood pressure was observed across different developmental stages, with the strongest association seen among preschool-aged children.
- Associations with diastolic blood pressure were observed in older children but not in preschool-aged participants.
- Similar relationships between OSA and blood pressure were observed in boys and girls, with no significant sex-based interaction.
The findings suggest that age may influence the link between OSA and cardiovascular risk, while severe OSA remains independently associated with morning hypertension despite obesity.
The study’s limitations included its retrospective design and clinical cohort, which may limit generalizability. The researchers recommended routine blood pressure monitoring in children with OSA, particularly those with severe disease, for early cardiovascular risk detection.
Reference:
Bellary, R., Nair, A., Malavika, P., Naidugari, J., Jawad, K., Orangias, M. S., El-Kersh, K., & Senthilvel, E. (2026). Obstructive sleep apnea severity and morning hypertension in children: Age-stratified associations across developmental stages. Sleep Medicine, 148, 109187. https://doi.org/10.1016/j.sleep.2026.109187
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