Children With Persistent Sleep Apnea Suffer Cardiovascular Consequences As Teens

A new report shows children who suffer from persistent obstructive sleep apnea (OSA) are nearly three times as likely to experience elevated blood pressure as teenagers.

The report suggests that intervening to address OSA could help prevent the development of cardiovascular problems in future years. The research finding were published in the JAMA Cardiology.

Julio Fernandez-Mendoza

Corresponding author Julio Fernandez-Mendoza, Ph.D., of the Penn State University College of Medicine, told Managed Healthcare Executive® that OSA has typically been studied in children with regard to its links to issues like attention deficits, hyperactivity and sleepiness. However, he said cross-sectional studies have also suggested that children with OSA have higher rates of high blood pressure or other cardiovascular issues. Some children with OSA also are obese, which is also a risk factor for cardiovascular disease, he noted.

“With all this in mind, there was a need to examine whether indeed having OSA as a child was related to having elevated blood pressure, but not in a cross-sectional manner,” he said. Instead, Fernandez-Mendoza looked at child as they transitioned to adolescence.

In the new report, Fernandez-Mendoza and colleagues tracked 421 children from the Penn State Child Cohort. The children were enrolled between 2000 and 2005, when they were between the ages of 5 and 12. The follow-up period was 2010 and 2013, by which point the enrollees were between the ages of 12 and 23 years old, with an average age of 16.5 at follow-up. A slight majority (53.9%) were male, and nearly one-quarter (21.9%) were racial or ethnic minorities.

Children who had persistent apnea-hypopnea index scores of 2 or more since childhood had a higher risk of adolescent elevated blood pressure. Apnea is a complete pause in breathing and hypopnea, a period of shallow breathing.

However, children who had a nonpersistent apnea-hypopnea index of 2 or more did not have a higher risk. As one might expect, the higher the patient’s apnea-hypopnea score, the higher the risk of elevated blood pressure, the investigators found, with the highest risk among patients with apnea-hypopnea index scores of 5 or more.

Fernandez-Mendoza and colleagues found the risk was significantly greater among males than females. Males and females have nearly equal risk of OSA as children, he noted, but boys tend to have a greater risk of OSA once they become teenagers.

“Previous evidence has suggested that hormonal and metabolic factors explain the greater cardiovascular resilience observed in females, who despite persisting with OSA do not show increased risk of hypertension in adolescence,” he said.

Fernandez-Mendoza said one likely factor in both OSA and hypertension in this age group is visceral adiposity. But he said the causal relationships involved are likely more complex than mere binary relationships between obesity and OSA and obesity and elevated blood pressure.

“Our data indicate that in adolescents, when metabolic factors are playing a significant role, visceral adiposity is tightly linked to the presence of OSA,” he said. “However, OSA itself appears to further contribute to increased blood pressure. We can say that, once persistent, OSA becomes part of a cardiometabolic vicious cycle, where chronic low-grade inflammation also plays a key role, as shown by ours and others’ previous studies.”

All of this underscores the need for multidimensional and multifactorial interventions at a young age, he said, targeting OSA, blood pressure, and body weight.