Obstructive sleep apnea is common in children and may impact blood pressure and heart health – sciencedaily

“The likelihood of children having trouble breathing while sleeping and, in particular, obstructive sleep apnea, may be due to the enlargement of a child’s tonsils, adenoids, or facial structure, however, it is important for parents to recognize that obesity also puts children at risk for obstructive sleep apnea, ”said statement writing group chair 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. “Sleep disturbances from sleep apnea have the potential to increase blood pressure and are linked to insulin resistance and abnormal lipids, all of which can negatively impact overall cardiovascular health later on. in life.”

Sleeping breathing disorders occur when a person experiences abnormal episodes of labored breathing, snoring, and snoring while asleep. It includes a range of conditions from snoring to obstructive sleep apnea (OSA). OSA is associated with cardiovascular disease in adults, but less is known about how the disease affects the immediate and long-term heart health of children and adolescents. The research examined for the statement reveals the following:

• Obstructive sleep apnea disrupts normal, restful sleep, which can impact emotional health, as well as the immune, metabolic, and cardiovascular systems in children and adolescents.
• It is estimated that 1 to 6% of all children and adolescents suffer from obstructive sleep apnea.
• About 30 to 60% of adolescents who meet criteria for obesity (BMI? 95^e percentile) also suffer from obstructive sleep apnea.

Risk factors for obstructive sleep apnea in children can vary with age; in general, the main factors are obesity, diseases of the upper and lower respiratory tract, allergic rhinitis, poor muscle tone, enlarged tonsils and adenoids, craniofacial malformations and neuromuscular disorders. Sickle cell disease has also been reported as an independent risk factor for OSA. Children born prematurely (before 37 weeks gestation) may be at an increased risk for sleep breathing disorders, in part due to a delay in the development of respiratory control and the smaller size of the upper airways. However, this risk appears to decrease as children born prematurely age and grow older.

OSA can be present in children with the following symptoms:

• habitual snoring, more than 3 nights per week;
• gasping or sniffling during sleep;
• labored breathing during sleep;
• sleeping in a seated position or with the neck hyperextended;
• Daytime sleepiness;
• headache on waking; or
• signs of upper airway obstruction.

The statement reiterates the American Academy of Otolaryngology, Head and Neck Surgery recommendation that a sleep study, called a polysomnography, is the best test for diagnosing sleep breathing disorders. They recommend a sleep study before tonsillectomy in children with sleep breathing disorders who have conditions that increase their risk of complications during surgery, such as obesity, Down syndrome, craniofacial abnormalities (eg, cleft palate), neuromuscular disorders (for example, muscular dystrophy) or sickle cell anemia. Children with these conditions and OSA are considered to be at high risk for respiratory complications during any surgery. Anesthetic drugs should be carefully considered and breathing should be closely monitored after surgery.

Children and adolescents with OSA can also have higher blood pressure. The statement details high blood pressure while sleeping, which is normally more than 10% lower than the blood pressure of a person awake. Research shows that children and youth with OSA have lower blood pressure drop during sleep, which may indicate abnormal blood pressure regulation. In studies on adults, “non-dip” is associated with a higher risk of cardiovascular events. The statement suggests that children and adolescents with OSA have their blood pressure measured over a full 24-hour period to capture measurements of wakefulness and sleep given the likelihood of higher blood pressure at night.

Metabolic syndrome is another concern for children with even mild OSA (as little as 2 episodes of breathing pauses per hour). This syndrome includes a combination of factors such as high insulin and triglyceride levels, high blood pressure and low levels of high density lipoproteins (HDL, the “good” cholesterol). Continuous positive airway pressure (CPAP), a treatment for OSA, can dramatically lower triglyceride levels and improve HDL levels. Treatment of OSA may also improve factors of metabolic syndrome, at least in the short term. However, obesity status may be the main reason for certain metabolic factors, such as poor insulin control.

“Obesity is a significant risk factor for sleep disorders and obstructive sleep apnea, and the severity of sleep apnea can be improved with weight loss interventions, which in turn ameliorates the factors of the sleep. Metabolic syndrome such as insulin sensitivity, ”Baker-Smith said. “We need to raise awareness of the impact of the increasing prevalence of obesity on the quality of sleep in children and recognize sleep breathing disorders as something that could contribute to the risk of hypertension and later cardiovascular disease. “

The statement also describes research that suggests a risk of pulmonary hypertension in children and adolescents with severe long-term OSA. The Editorial Board also identifies the need for further studies on the risk of cardiovascular disease associated with OSA in children that incorporate 24-hour blood pressure monitoring and measures of metabolic syndrome factors.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Atherosclerosis, Hypertension and Obesity in the Young subcommittee of the Council on Cardiovascular Disease in the Young.

The co-authors are Justin Zachariah, MD, vice president; Amal Isaiah, MD; Maria Cecilia Melendres, MD; Joseph Mahgerefteh, MD; Anayansi Lasso-Pirot, MD; Shawyntee Mayo, MD, MPH; and Holly Gooding, MD, M.Sc. Author disclosures are in the manuscript.