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(Chest. 2006;130:1009-1017.)
© 2006 American College of Chest Physicians

Twenty-Four–Hour Ambulatory BP in Snoring Children With Obstructive Sleep Apnea Syndrome*

Lettie C.K. Leung, FHKAM (Paed), FRCP; Daniel K. Ng, FHKAM (Paed), MMedSc; Michael W. Lau, FHKAM (Paed), MRCP; Chung-hong Chan, BSc; Ka-li Kwok, FHKAM (Paed), FRCP; Pok-yu Chow, FHKAM (Paed), MRCP and Josephine M.Y. Cheung, RN, RPSGT, MSc (Nurs)

* From the Department of Paediatrics, Kwong Wah Hospital, Hong Kong SAR, China.

Correspondence to: Daniel K. Ng, FHKAM, MMedSc, Consultant Pediatrician, Department of Pediatrics, Kwong Wah Hospital, Waterloo Rd, Hong Kong SAR, China; e-mail: dkkng{at}ha.org.hk

Abstract

Introduction: Obstructive sleep apnea syndrome (OSAS) is a known risk factor for hypertension in adults. This relationship is less clear in childhood OSAS.

Objective: This study examined the relationship between OSAS and 24-h ambulatory BP (ABP), a more accurate assessment than casual BP, in children with snoring.

Methods: Snoring children aged 6 to 15 years who underwent polysomnography in the sleep laboratory were recruited.

Measurement: Twenty-four–hour ABP monitoring was initiated a few hours before polysomnography. The children were classified into two groups: a high apnea-hypopnea index (AHI) group (obstructive AHI > 5/h), and a low-AHI group (AHI ≤ 5/h). Mean sleep, wake, and 24-h systolic BP (SBP) and diastolic BP (DBP) were recorded. A child was considered a "nondipper" if his or her mean SBP and DBP did not decrease by ≥ 10% during sleep.

Results: Ninety-six children (mean age ± SD, 9.4 ± 2.8 years) were recruited. Forty-one children were obese. When awake, the high-AHI group children had a significantly higher SBP. When asleep, both SBP and DBP were higher in the high-AHI group. Age, body mass index (BMI) z score, and desaturation index (DI) were significant predictors for elevated sleep DBP. BMI z score was the only significant predictor for wake and sleep SBP. Sixteen children (17%) had hypertension, and all were nondippers. Obese children in the high-AHI group had a significantly higher prevalence of hypertension than obese children in the low-AHI group. This relationship was not found in nonobese children.

Conclusion: The current study shows that increased DI contributed to the elevation of sleep DBP elevation.

Key Words: BP monitoring, ambulatory • child • hypertension • sleep apnea, obstructive






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