Sleep apnea not always linked to hypertension in adolescence

Obstructive sleep apnea is a risk factor for elevated blood pressure in adults. The potential association between obstructive sleep apnea in childhood with elevated blood pressure in adolescents is little known. A report in JAMA Cardiology looked at the association.¹

The investigators used the Penn State Child Cohort, which included 700 children aged 5 to 12 years from the general population, of which 421 participants were followed up with in 2010-2013. The outcomes examined included the apnea-hypopnea index score, which was found through polysomnography performed in a laboratory; visceral adipose tissue, which was assessed using dual-energy x-ray absorptiometry; blood pressure, measured in a seated position using guideline-recommended pediatric criteria; and orthostatic hyperreactivity, examined in supine and standing positions.

The average age of the 421 participants was 16.5 years and the 53.9% were male. Investigators found that a persistent apnea-hypopnea index score of 2 or more since childhood was longitudinally linked with adolescent elevated blood pressure (odds ratio [OR], 2.9; 95% CI 1.1-7.5), whereas a remitted apnea-hypopnea index score of 2 or more did not have this link. Obstructive sleep apnea in adolescence was also linked to elevated blood pressure, but in a dose-response manner, with an apnea-hypopnea index score of 2 to less than 5 being nonsignificant (OR, 1.5; 95% CI, 0.9-2.6) and an apnea-hypopnea index score of 5 or more was roughly 2-fold (OR, 2.3; 95% CI, 1.1-4.9) following adjustment for visceral adipose tissue. Additionally, an apnea-hypopnea index score of 5 or more was linked to orthostatic hyperreactivity, even with adjustment for visceral adipose tissue, but this wasn’t seen with an apnea-hypopnea index score of 2 to less than 5.

The investigators concluded that childhood obstructive sleep apnea is linked to hypertension in adolescence only if the apnea is persistent. Visceral adiposity appears to largely explain this link.

Reference

1. Fernandez-Mendoza J, He F, Calhoun S, Vgontzas A, Liao D, Bixler E. Association of pediatric obstructive sleep apnea with elevated blood pressure and orthostatic hypertension in adolescence. JAMA Cardiol. June 23, 2021. Epub ahead of print. doi:10.1001/jamacardio.2021.2003