Obstructive sleep apnea is common in kids and may impact blood pressure,
heart health

Date:
August 18, 2021
Source:
American Heart Association
Summary:
Children and adolescents can experience sleep-disordered breathing
and obstructive sleep apnea, like adults. An estimated 1-6% of all
children and adolescents have obstructive sleep apnea. The sleep
disruptions and pauses in breathing from sleep apnea may be linked
to obesity, lipid disorders, elevated blood pressure and changes
in heart structure in kids.



FULL STORY ========================================================================== Obstructive sleep apnea, a form of sleep-disordered breathing, is common
in children and adolescents and may 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 statement is an
expert analysis of current research and may inform future guidelines.


==========================================================================
"The likelihood of children having disordered breathing during sleep
and, in particular, obstructive sleep apnea, may be 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 statement writing group chair Carissa
M. Baker-Smith, M.D., M.P.H., M.S., director of pediatric preventive
cardiology at the Nemours Children's Hospital in Wilmington, Delaware,
and associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

"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." Sleep-disordered breathing is when someone experiences abnormal episodes of labored breathing, snoring and snoring sounds during sleep. It includes a spectrum of conditions from snoring to obstructive sleep apnea (OSA). OSA 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 the following:
* 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% of all children and adolescents have 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 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 OSA. Children who were born premature (before 37 weeks gestation)
may have 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.

OSA may be present in children with the following symptoms:
* habitual snoring, more than 3 nights per week; * gasps or snorting
noises while sleeping; * labored breathing during sleep; * sleeping
in a seated position or with neck hyperextended; * daytime sleepiness;
* headache upon waking up; or * signs of upper airway obstruction.

The statement reiterates the recommendation of the American Academy of Otolaryngology and Head and Neck Surgery that a sleep study, called polysomnography, 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 (e.g., cleft palate), neuromuscular disorders
(e.g., muscular dystrophy) or sickle cell disease. Children with these conditions and OSA 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 OSA may also have higher blood pressure. The statement details elevated sleeping blood pressure, which is normally more
than 10% lower than a person's blood pressure level when awake. Research
shows that children and youth with OSA 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 suggests that
children and adolescents with OSA 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 OSA
(as few as 2 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 OSA, can significantly lower triglyceride levels and
improve HDL levels. Treating OSA 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," Baker-Smith said. "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 outlines research that
suggests a risk for pulmonary hypertension in children and adolescents
that have long-term severe OSA. The writing committee also identifies
the need for additional studies of cardiovascular disease risk associated
with OSA 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 are Justin Zachariah, M.D., vice-chair; Amal Isaiah, M.D.;
Maria Cecilia Melendres, M.D.; Joseph Mahgerefteh, M.D.; Anayansi
Lasso-Pirot, M.D.; Shawyntee Mayo, M.D., M.P.H.; and Holly Gooding,
M.D., M.Sc. Author disclosures are in the manuscript.

========================================================================== Story Source: Materials provided by American_Heart_Association. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Carissa M. Baker‐Smith, Amal Isaiah, Maria Cecilia Melendres,
Joseph Mahgerefteh, Anayansi Lasso‐Pirot, Shawyntee Mayo,
Holly Gooding, Justin Zachariah. Sleep‐Disordered Breathing
and Cardiovascular Disease in Children and Adolescents. Journal of
the American Heart Association, 2021; DOI: 10.1161/JAHA.121.022427 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/08/210818083915.htm

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