Preschool Children with Obstructive Sleep Apnea: The Beginnings of Elevated Blood Pressure?

被引：61
|
作者：
Nisbet, Lauren C. [1 ]
Yiallourou, Stephanie R. [1 ]
Biggs, Sarah N. [1 ]
Nixon, Gillian M. [1 ,2 ]
Davey, Margot J. [1 ,2 ]
Trinder, John A. [3 ]
Walter, Lisa M. [1 ]
Horne, Rosemary S. C. [1 ]
机构：
[1] Monash Univ, Monash Inst Med Res, Ritchie Ctr, Melbourne, Vic 3004, Australia
[2] Monash Med Ctr, Monash Childrens Programme, Melbourne Childrens Sleep Ctr, Melbourne, Vic, Australia
[3] Univ Melbourne, Discipline Psychol Sci, Melbourne, Vic, Australia
来源：
SLEEP | 2013年 / 36卷 / 08期
基金：
英国医学研究理事会;
关键词：
Blood pressure; children; obstructive sleep apnea; preschool; pulse transit time; snoring; PULSE TRANSIT-TIME; HYPERTENSION; CHILDHOOD; AROUSAL; EVENTS;
D O I：
10.5665/sleep.2890
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Study Objectives: In adults and older children, snoring and obstructive sleep apnea (OSA) are associated with elevated blood pressure (BP). However, BP has not been assessed in preschool children, the age of highest OSA prevalence. We aimed to assess overnight BP in preschool children with snoring and OSA using pulse transit time (PTT), an inverse continuous indicator of BP changes. Design: Overnight polysomnography including PTT. Children were grouped according to their obstructive apnea-hypopnea index (OAHI); control (no snoring, with OAHI of one event or less per hour), primary snoring (OAHI one event or less per hour), mild OSA (OAHI greater than one event to five events per hour) and moderate-severe OSA (OAHI more than five events per hour). Setting: Pediatric sleep laboratory. Patients: There were 128 clinically referred children (aged 3-5 years) and 35 nonsnoring community control children. Measurement and Results: PTT was averaged for each 30-sec epoch of rapid eye movement (REM) or nonrapid eye movement (NREM) sleep and normalized to each child's mean wake PTT. PTT during NREM was significantly higher than during REM sleep in all groups (P < 0.001 for all). During REM sleep, the moderate-severe OSA group had significantly lower PTT than the mild and primary snoring groups (P < 0.05 for both). This difference persisted after removal of event-related PTT changes. Conclusions: Moderate-severe OSA in preschool children has a significant effect on pulse transit time during REM sleep, indicating that these young children have a higher baseline BP during this state. We propose that the REM-related elevation in BP may be the first step toward development of daytime BP abnormalities. Given that increased BP during childhood predicts hypertension in adulthood, longitudinal studies are needed to determine the effect of resolution of snoring and/or OSA at this age.
引用
收藏
页码：1219 / 1226
页数：8
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