Persistent Childhood Sleep Apnea Linked With Increased Risk of High Blood Pressure Later

Children whose sleep apnea persist into adolescence have a 3-fold increased risk of high blood pressure and face an elevated risk of heart disease.

Children with obstructive sleep apnea are 3 times more likely to endure high blood pressure when they enter adolescence compared with unaffected children, while children whose sleep apnea improves as they enter adolescence face no increased risk of high blood pressure, which is a strong contributor to heart disease.

The long-term, population-based, cohort study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, and results were published online in the journal JAMA Cardiology.

Researchers admitted 421 children aged 5-12 and evaluated them for sleep apnea and high blood pressure. After monitoring them in a sleep lap overnight, researchers observed that about 51 children (12%) had obstructive sleep apnea.

The same participants were evaluated for sleep apnea and high blood pressure again after 8 years, between the ages 12-23. Researchers observed that children whose sleep apnea had persisted into adolescence were about 3 times more likely to develop high blood pressure compared to unaffected children.

Participants who developed sleep apnea in their teenage years and satisfied adult diagnostic criteria were about 2 times more likely to develop high blood pressure than those without sleep apnea. Further, these participants were more likely to develop orthostatic hypertension, a type of high blood pressure which puts them at greater risk for heart disease in adulthood.

While the biological mechanisms driving the relationship between childhood sleep apnea and elevated blood pressure in adolescence are unclear, researchers suggest increased inflammation, oxidative stress, and impaired heart function caused by changes in the sympathetic nervous system may contributing factors. This finding is supported by the independent contribution of sleep apnea to high blood pressure and orthostatic hypertension.

An estimated 10% of school-aged children suffer from sleep apnea, half of who outgrow the disorder as they enter adolescence and half of whose condition does not improve over time. Physicians suggest that early treatment may be of great benefit to the long-term cardiovascular health of children.

“Our study showed that pediatric sleep apnea can act as a gateway to future hypertension,” lead study author Julio Fernandez-Mendoza, PhD, said in a statement. “Because most cases of sleep apnea go undiagnosed in adults and children alike the problem needs more attention. Sleep apnea and its risk factors should be screened for, monitored, and targeted early in life to prevent future cardiovascular disease.”

Pediatric sleep apnea and adult sleep apnea can be treated through methods including the surgical removal of the tonsils and adenoids or the use of a continuous positive airway pressure (CPAP) machine. Since obesity is a driving factor of sleep apnea even at a young age, following a healthy eating and exercise plan can help with managing the sleep disorder.

Fernandez-Mendoza is conducting another evaluation of the study participants who are now between the ages 20-31. He hopes to develop a comprehensive understanding of the long-term impact of childhood sleep apnea on cardiovascular health in adulthood.

Reference

Fernandez-Mendoza, J, He, F, Calhoun, S, et al. Association of pediatric obstructive sleep apnea with elevated blood pressure and orthostatic hypertension in adolescence. JAMA Cardiol. Published online June 23, 2021. doi:10.1001/jamacardio.2021.2003