AHA-HBP: Hypertensive Children At Risk for Sleep Apnea

SAN ANTONIO, Oct. 9 -- Children with high blood pressure are more likely to snore and have other sleep-disordered breathing problems than normotensive peers, researchers said here.

Hypertension is known to be a risk factor for obstructive sleep apnea in adults. But a small study reported at the American Heart Association's Council for High Blood Pressure Research conference has linked the relationship to children as well.

Children with enlarged tonsils and hypertension were more than twice as likely to have sleep-disordered breathing than those with adenotonsillar hypertrophy alone (odds ratio 2.16, 95% confidence interval 1.18 to 3.95, P

Dr. Acosta said her clinic routinely screens pediatric patients with hypertension for sleep-disordered breathing risk factors. When children have snoring, enlarged tonsils, a body mass index above the 85th percentile, or nocturnal hypertension by ambulatory blood pressure monitoring, they are selected to undergo nocturnal polysomnography.

Of the study participants, 55% had nocturnal hypertension (11) and 85% had adenotonsillar hypertrophy (17). Seventeen had a body mass index above the 95th percentile (85%), and one child was at the 90th percentile for height, weight and gender.

Sleep disordered breathing was found by nocturnal polysomnography in 60% of the participants (12 of 20).

Of these, seven had obstructive sleep apnea defined as more than one episode of apnea per hour. Another four had obstructive hypoventilation, defined as a maximum partial pressure of carbon dioxide in the blood of more than 53 torr during sleep or greater than 50 torr during more than 10% of sleep or both. One patient had mild sleep disordered breathing, defined as 1.5 apneas and hypopneas per hour.

Among the remaining eight patients without sleep disordered breathing, six had a primary snoring disorder and two had normal polysomnography without snoring.

The researchers said that based on their findings, hypertension in children may constitute an additional risk factor for sleep disordered breathing in addition to obesity and enlarged tonsils, which have previously been shown to be risk factors.

However, since the study was limited by the small number of participants, further studies are needed to confirm the relationship between sleep disordered breathing and hypertension, Dr. Acosta and colleagues noted.

Dr. Acosta suggested that lifestyle changes, such as weight loss and a low-salt-diet, may reduce the risk of sleep disordered breathing in children with hypertension.