Obstructive sleep apnea is widespread in kids and might have an effect on blood strain and coronary heart well being

Illustration of obstruction to ventilation. Photo credit: Habib M’henni / public domain

Obstructive apnea, a form of breathing disorder during , is common in children and adolescents and can be associated with elevated blood pressure and changes in heart structure, according to a new scientific statement from the American Heart Association, published today in the Journal of the American Heart Association. A scientific opinion is an expert analysis of current research and may inform future policy.

“The likelihood that children will experience breathing disorders, and obstructive sleep apnea in particular, during sleep may be due to enlargement of a child’s tonsils, adenoids or facial structure, but it is important for parents to realize that obesity affects children too risk of obstructive sleep apnea,” said Carissa M. Baker-Smith, chief of pediatric preventive cardiology at Nemours Children’s Hospital in Wilmington, Delaware, and associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia of sleep apnea can increase blood pressure and are associated with insulin resistance and abnormal lipids, all of which can adversely affect overall cardiovascular health later in life.”

A sleep-disordered breathing disorder is when someone experiences abnormal episodes of labored breathing, snoring, and snoring noises during sleep. It spans a spectrum of conditions from snoring to obstructive sleep apnea (OSA). OSA is associated with cardiovascular in adults, but less is known about how the affects immediate and long-term heart health in children and adolescents. The research reviewed for the statement shows the following:

  • Obstructive sleep apnea disrupts normal, restful sleep, which can affect emotional health, as well as the immune, metabolic, and cardiovascular systems in children and adolescents.
  • An estimated 1-6% of all children and adolescents suffer from obstructive sleep apnea.
  • About 30-60% of adolescents who meet the criteria for obesity (BMI ≥ 95th percentile) also have obstructive sleep apnea.

Risk factors for obstructive sleep apnea in children may vary with age; In general, the primary contributors are obesity, upper and lower respiratory tract , allergic rhinitis, low muscle tone, enlarged tonsils and adenoids, craniofacial malformations, and neuromuscular disorders. Sickle cell anemia has also been described as an independent risk factor for OSA. Premature infants (less than 37 weeks gestation) may be at increased risk for breathing disorders during sleep, in part due to the delayed development of respiratory control and the smaller size of the upper airway. However, this risk appears to decrease with increasing age and growth of preterm infants.

OSA can occur in children with the following symptoms:

  • ordinary snoring, more than 3 nights a week;
  • wheezing or snorting noises when sleeping;
  • difficult breathing during sleep;
  • sleeping sitting up or with your neck craned;
  • daytime fatigue;
  • headache on waking; or
  • Signs of upper airway obstruction.

The statement reiterates the American Academy of Otolaryngology and Head and Neck Surgery’s recommendation that a sleep study, called polysomnography, is the best test for diagnosing sleep breathing disorders. They recommend a sleep study prior to tonsillectomy in children with sleep breathing disorders who have medical conditions that increase their risk for complications during surgery, such as obesity, Down syndrome, craniofacial abnormalities (e.g., cleft palate), neuromuscular disorders (e.g., B. muscular dystrophy). ) or sickle cell anemia. Children with these conditions and OSA are at high risk of respiratory complications during any surgery. Anesthetic agents should be carefully weighed and breathing should be closely monitored after surgery.

Children and adolescents with OSA may also have higher blood pressure. The statement describes elevated blood pressure during sleep, which is typically more than 10% lower than a person’s blood pressure while they are awake. Research shows that children and adolescents with OSA have less of a drop in blood pressure during sleep, which may indicate abnormal blood pressure regulation. In adult studies, non-dipping is associated with a higher risk of cardiovascular events. The statement suggests that children and adolescents with OSA should have their blood pressure measured over a 24-hour period to record levels of waking and sleeping because of the likelihood of higher nocturnal blood pressure.

Metabolic syndrome is another problem for children with even mild OSA (only 2 episodes of pauses in breathing per hour). This syndrome involves a number of factors such as high levels of insulin and triglycerides, elevated blood pressure and low levels of high-density lipoprotein (HDL, the “good” cholesterol). Continuous positive airway pressure (CPAP), a treatment for OSA, can significantly lower triglyceride levels and improve HDL levels. Treating OSA can also ameliorate the factors of metabolic syndrome, at least in the short term. However, obesity status can be the main reason for some metabolic factors such as: B. Poor insulin control.

“Obesity is a significant risk factor for sleep disorders and obstructive sleep apnea, and sleep apnea severity can be improved by weight loss interventions, which then improve metabolic syndrome factors such as insulin sensitivity,” Baker-Smith said. “We need to raise awareness of how the increasing prevalence of obesity can affect sleep quality in children, and recognize sleep disordered breathing as something that could contribute to risks of hypertension and later cardiovascular disease.”

The statement also outlines research suggesting a risk of pulmonary hypertension in children and adolescents who have severe long-term OSA. The editorial committee also identifies the need for additional studies on the risk of cardiovascular disease associated with childhood OSA that include 24-hour blood pressure monitoring and measurements of metabolic syndrome factors.

This scientific statement was prepared by the Volunteer Writing Group on behalf of the American Heart Association’s Subcommittee on Atherosclerosis, Hypertension and Obesity of the Council on Cardiovascular Disease in the Young of the American Heart Association.

Children with sleep apnea through their teens can develop high blood pressure

More information:
Baker-Smith, Carissa M et al., Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents, Journal of the American Heart Association (2021). DOI: 10.1161/JAHA.121.022427 Provided by the American Heart Association

Quote: Obstructive sleep apnea is common in children and can affect blood pressure, Heart Health (2021 August 18) retrieved January 20, 2022 from https://medicalxpress.com/news/2021-08-obstructive-apnea- common-kids-impact.html

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