WASHINGTON — Obstructive sleep apnea, a condition in which breathing stops involuntarily for brief periods of time during sleep, is common in children and adolescents and may be associated with elevated blood pressure and changes in heart structure, as per a new scientific statement from the American Heart Association.
The findings of the research were published in the “Journal of the American Heart Association.”
“The likelihood of children having disordered breathing during sleep and, in particular, obstructive sleep apnea, maybe due to enlargement of the tonsils, adenoids or a child’s facial structure, however, it is important for parents to recognize that obesity also puts kids at risk for obstructive sleep apnea,” said writing group chair Carissa M. Baker-Smith, director of pediatric preventive cardiology at the Nemours Children’s Hospital in Wilmington, Delaware.
“Sleep disruptions due to sleep apnea have the potential to raise blood pressure and are linked with insulin resistance and abnormal lipids, all of which may adversely impact overall cardiovascular health later in life.”
Obstructive sleep apnea is associated with cardiovascular disease in adults. However, less is known about how the condition affects the immediate and long-term heart health of children and adolescents.
The research reviewed for the statement reveals that obstructive sleep apnea disrupts normal, restorative sleep, which can impact emotional health, as well as the immune, metabolic and cardiovascular systems in children and adolescents.
An estimated 1-6 percent of all children and adolescents have obstructive sleep apnea, the findings suggest.
About 30-60 percent of adolescents who meet the criteria for obesity (Body Mass Index-for-age higher than the 95th percentile) also have obstructive sleep apnea.
Risk factors for obstructive sleep apnea in children may vary with age; in general, the primary factors are obesity, upper and lower airway disease, allergic rhinitis, low muscle tone, enlarged tonsils and adenoids, craniofacial malformations, and neuromuscular disorders.
Sickle cell disease has also been reported as an independent risk factor for obstructive sleep apnea. Children who were born premature (before 37 weeks of gestation) may have an increased risk for sleep-disordered breathing, partly due to delayed development of respiratory control and the smaller size of the upper airway.
However, this risk appears to decrease as children who are born premature age and grow.
Obstructive sleep apnea may be present in children with a wide range of symptoms, in particular: habitual snoring, more than three nights per week; gasps or snorting noises while sleeping; labored breathing during sleep; sleeping in a seated position or with the neck hyperextended; daytime sleepiness; headache upon waking up; or signs of upper airway obstruction.
The statement reiterated the recommendation of the American Academy of Otolaryngology and Head and Neck Surgery that polysomnography — a type of sleep study — is the best test for diagnosing sleep-disordered breathing.
They recommend a sleep study before a tonsillectomy in children with sleep-disordered breathing who have conditions that increase their risk for complications during surgery, such as obesity, Down syndrome, craniofacial abnormalities (such as cleft palate), neuromuscular disorders (like muscular dystrophy), or sickle cell disease.
Children with these conditions and obstructive sleep apnea are considered at high risk for breathing complications during any surgery. Anesthesia medicine should be carefully considered, and breathing should be closely monitored after surgery.
Children and adolescents with obstructive sleep apnea may also have higher blood pressure. The statement detailed elevated sleeping blood pressure, which is normally more than 10 percent lower than a person’s blood pressure level when awake.
Research showed that children and youth with obstructive sleep apnea have a smaller dip in blood pressure while asleep, which may indicate abnormal blood pressure regulation.
In studies of adults, “non-dipping” is associated with a higher risk of cardiovascular events.
The statement suggested that children and adolescents with obstructive sleep apnea have their blood pressure measured over a full 24-hour period to capture waking and sleeping measurements, given the likelihood for higher nighttime blood pressure.
Metabolic syndrome is another concern for children with even mild obstructive sleep apnea (as few as two episodes of pauses in breathing per hour).
This syndrome includes a cluster of factors such as high insulin and triglyceride levels, elevated blood pressure, and low levels of high-density lipoprotein (HDL, the “good” cholesterol).
Continuous positive airway pressure (CPAP)—a treatment for obstructive sleep apnea—can significantly lower triglyceride levels and improve high-density lipoprotein levels.
Treating obstructive sleep apnea may also improve the factors of metabolic syndrome, at least in the short term. However, obesity status may be the main reason for some metabolic factors, such as poor insulin control.
“Obesity is a significant risk factor for sleep disturbances and obstructive sleep apnea, and the severity of sleep apnea may be improved by weight loss interventions, which then improves metabolic syndrome factors such as insulin sensitivity,” said Baker-Smith, who is also an associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
“We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease.”
The statement also outlined research that suggested a risk for pulmonary hypertension in children and adolescents that have long-term severe obstructive sleep apnea.
The writing committee also identified the need for additional studies of cardiovascular disease risk associated with obstructive sleep apnea in childhood that incorporate 24-hour blood pressure monitoring and measures of metabolic syndrome factors.
This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Atherosclerosis, Hypertension, and Obesity in the Young subcommittee of the Council on Cardiovascular Disease in the Young.
Co-authors included Justin Zachariah, vice-chair; Amal Isaiah, Maria Cecilia Melendres, Joseph Mahgerefteh, Anayansi Lasso-Pirot, Shawyntee Mayo, and Holly Gooding.
(With inputs from ANI)
Edited by Amrita Das and Krishna Kakani
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