High Hypoxic Burden in Sleep Apnea Linked to Elevated Nighttime BP in Children: Study
Spain: A recent secondary analysis published in JAMA Network Open has highlighted that a higher hypoxic burden (HB) — a measure of oxygen desaturation during sleep — may serve as an early marker of cardiovascular risk in children with obstructive sleep apnea (OSA).
In the research, conducted as part of the ongoing Kids Trial, by Dr. Olga Mediano from the Sleep Unit, Pneumology Department, Hospital Universitario de Guadalajara, Spain, and colleagues explored whether HB levels were linked to abnormal nighttime blood pressure (BP) patterns, which are early indicators of cardiovascular disease. The analysis included 190 children with suspected OSA, with a median age of six years, and around 57% of them were boys.
Each participant underwent polysomnography and 24-hour ambulatory BP monitoring to assess breathing disturbances and fluctuations in blood pressure during sleep. HB was quantified as the area under the oxygen desaturation curve for each respiratory event, reflecting the overall burden of hypoxia experienced during sleep.
The study revealed the following notable findings:
- Children with higher hypoxic burden (HB) values had greater nighttime diastolic blood pressure (58 mmHg) compared with those with the lowest HB levels (56 mmHg).
- Their nocturnal blood pressure dipping, the normal reduction in BP during sleep, was significantly lower at 8.9 mmHg compared with 13.5 mmHg in children with lower HB.
- The likelihood of having a non-dipping BP pattern, a known cardiovascular risk factor, was almost twice as high in those with elevated HB (55.3% vs 31.9%), with an odds ratio of 2.41.
According to the authors, these findings suggest that hypoxic burden may be an effective biomarker for cardiovascular risk stratification in pediatric sleep apnea. Children with higher HB values showed early signs of altered BP regulation, which, if left unchecked, could increase their vulnerability to long-term cardiovascular complications. The study also builds on prior research in adults, where HB has been established as a strong predictor of cardiovascular risk, extending its potential relevance to younger populations where early intervention could have lifelong benefits.
The authors acknowledged certain limitations. Since this was a cross-sectional secondary analysis, it could not establish a cause-and-effect relationship between HB and cardiovascular outcomes. Moreover, HB categorization was based on quartiles rather than standardized clinical thresholds, potentially limiting the applicability of the findings. The possibility of residual confounding due to unmeasured variables was also recognized.
Despite these limitations, this analysis addresses a critical gap in pediatric sleep medicine by identifying hypoxic burden as a promising early indicator of cardiovascular risk in children with sleep apnea. The authors emphasized that incorporating HB assessment into clinical evaluations could enhance early diagnosis, guide treatment strategies, and improve long-term cardiovascular health outcomes in affected children.
"The study reinforces that sleep-related breathing disorders in children deserve early attention, not only to improve sleep quality but also to safeguard heart health from an early age," the authors concluded.
Reference:
Mediano O, López-Monzoni S, Castillo-García M, et al. Cardiovascular Risk Through Hypoxic Burden in Children With Sleep Apnea: A Secondary Analysis of a Nonrandomized Clinical Trial. JAMA Netw Open. 2025;8(10):e2538744. doi:10.1001/jamanetworkopen.2025.38744
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