Pediatric obstructive sleep apnea linked to hypertension later in life
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Children with obstructive sleep apnea experienced increased risk for future hypertension when the sleep disorder persisted during the developmental transition to adolescence, researchers reported in JAMA Cardiology.
Julio Fernandez-Mendoza, PhD, associate professor and director of the Behavioral Sleep Medicine Accredited Training program at Penn State Health in Hershey, Pennsylvania, and colleagues conducted the population-based cohort study to determine the role of pediatric obstructive sleep apnea (OSA) in elevated BP and its orthostatic reactivity during adolescence. They enrolled a random sample of 700 children aged 5 to 12 years (median, 9 years). At 7.4 years, researchers followed up with 421 participants who were aged 12 to 23 years (median, 16 years).
Main outcomes and measures included apnea-hypopnea index (AHI) score, elevated BP, orthostatic hyperreactivity and visceral adipose tissue.
Mean age at follow-up was 16.5 years; 53.9% of participants were male and 21.9% were from a historically underrepresented background.
According to the researchers, a persistent AHI of 2 or more since childhood significantly increased the likelihood of adolescent elevated BP (OR = 2.9; 95% CI, 1.1-7.5), whereas a remitted AHI of 2 or more did not (OR = 0.9; 95% CI, 0.3-2.6). Adolescent OSA was linked to hypertension in a dose-response manner, the researchers found, with visceral adipose tissue and metabolic syndrome contributing to this association unless the adolescent had more severe OSA (AHI 5).
Furthermore, male participants were more likely to have OSA in adolescence than female participants (47.6% vs. 26.3%; P < .001), an increase not observed in childhood and closer to the figure reported in adults. In addition, male sex also increased the risk for hypertension in adolescence (39.6% vs. 16%; P < .001). The association between sex and hypertension, Fernandez-Mendoza and researchers wrote, “suggests that, at least for adolescent males, metabolic abnormalities are in the mechanistic pathway between OSA and hypertension.”
The researchers concluded that, when taken together with a previously reported cross-sectional association between childhood OSA and subclinical BP levels, the present data “indicate that childhood OSA should be monitored and targeted to prevent future adverse CV outcomes. Given the high remission rate of childhood OSA and the significant association of obesity with its persistence and incidence and with inflammation in the transition to adolescence, future studies should examine the inflammatory and vascular mechanisms of the longitudinal association of persistent childhood OSA with hypertension.”
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