Factors Associated With Blood Pressure in School-Age Children With Obstructive Sleep Apnea

Abstract

Background:

Children with obstructive sleep apnea (OSA) have an increased risk for high blood pressure (BP). Evidence suggests that arousals, total sleep time (TST), sleep efficiency, oxygen saturation, end-tidal carbon dioxide (ETCO₂) levels, inflammation, and body mass index (BMI) are associated with changes in BP. Yet, less is known about these relationships in school-aged children with OSA.

Objective:

This study aimed to determine factors associated with BP in school-aged children with OSA.

Methods:

A cross-sectional, secondary data analysis of 163 school-aged children (mean age of 7.15 ± 1.16, 62% black, 54.6% female) who participated in the Childhood Adenotonsillectomy Trial.

Results:

Systolic BP (r = 0.21, p < .01) and diastolic BP (DBP; r = 0.22, p < .01) had a positive relationship with BMI percentiles. The relationship between BMI percentiles and DBP remained when accounting for race and OSA severity (β = 0.19, p = .02). DBP also had a positive relationship with the log percentage of TST with ETCO₂ ≥50 mmHg (r = 0.23, p < .01) that persisted when accounting for BMI percentiles, OSA severity, and race (β = 0.23, p = .004). No other significant relationships were found.

Conclusions:

Findings suggest that BMI is a main driver of BP in school-aged children with OSA. Also, the percentage of TST with ETCO₂ ≥50 mmHg impacted BP in this sample and further research is needed to explore mechanisms behind these relationships. Clinicians and researchers should advocate for the assessment of all polysomnographic findings when assessing the risk for elevated BP and other comorbidities in children with OSA.