Sleep apnea common, may impact CVD in children, adolescents
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According to a scientific statement published in the Journal of the American Heart Association, obstructive sleep apnea is common among children and adolescents and may be associated with BP and heart structure.
“The likelihood of children having disordered breathing during sleep and, in particular, obstructive sleep apnea, may be due to enlargement of the tonsils, adenoids or a child’s facial structure; however, it is important for parents to recognize that obesity also puts kids at risk for obstructive sleep apnea,” Carissa M. Baker-Smith, MD, MPH, MS, director of pediatric preventive cardiology at Nemours Children’s Hospital in Wilmington, Delaware, and associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, said in a press release. “Sleep disruptions due to sleep apnea have the potential to raise blood pressure and are linked with insulin resistance and abnormal lipids, all of which may adversely impact overall cardiovascular health later in life.”
OSA prevalence, risk factors
Obstructive sleep apnea (OSA) has been diagnosed in 1% to 6% of all children and adolescents, with 30% to 60% of those adolescents meeting the criteria for obesity. In addition, the statement highlighted obesity, upper and lower airway disease, allergic rhinitis, low muscle tone, enlarged tonsils and adenoids, craniofacial malformations, neuromuscular disorders and sickle cell disease as the primary risk factors for OSA.
Researchers also revealed the following symptoms in children as associated with OSA:
- habitual snoring at least 3 nights per week;
- gasping or snorting during sleep;
- labored breathing during sleep;
- sleeping vertically or with neck hyperextended;
- daytime sleepiness;
- headache upon awakening; or
- upper airway obstruction symptoms.
Researchers recommended conduction polysomnography prior to tonsillectomy in children and adolescents with sleep-disordered breathing and noted that conditions likely to increase complication risk during surgery include obesity, Down syndrome, craniofacial abnormalities, neuromuscular disorders and sickle cell disease.
Researchers also noted that children and adolescents with OSA may be likely to experience higher BP. Normally, elevated sleeping BP is 10% lower than BP while awake, but children and adolescents with OSA demonstrated smaller BP dips during sleep. The statement highlighted a previous study showing 7.6% of children and adolescents with an apnea-hypopnea index of more than five events per hour experiencing a 10% BP dip compared with 11.5% of children and adolescents with primary snoring (P < .01). These findings prompted the researchers to suggest that children and adolescents with OSA have their BP measured during a full 24-hour period to assess waking and sleeping measurements.
Metabolic syndrome a concern
Finally, researchers highlighted metabolic syndrome as another concern for this patient population, including those with mild OSA. Continuous positive airway pressure treatment can affect important metabolic syndrome factors such as significantly lowering triglyceride levels and improving HDL levels, they wrote.
“Obesity is a significant risk factor for sleep disturbances and obstructive sleep apnea, and the severity of sleep apnea may be improved by weight-loss interventions, which then improves metabolic syndrome factors such as insulin sensitivity,” Baker-Smith said in the release. “We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease.”
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