Pediatric obstructive sleep apnea linked to hypertension lat
Children with obstructive sleep apnea experienced increased risk for future hypertension when the sleep disorder persisted during the developmental transition to adolescence, researchers reported in JAMA Cardiology.

Although pediatric guidelines have delineated updated thresholds for elevated blood pressure (eBP) in youth and adult guidelines have recognized obstructive sleep apnea (OSA) as an established risk factor for eBP, the relative association of pediatric OSA with adolescent eBP remains unexplored.

This study aimed to assess the association of pediatric OSA with eBP and its orthostatic reactivity in adolescence.

At baseline of this population-based cohort study (Penn State Child Cohort), a random sample of 700 children aged 5 to 12 years from the general population was studied. A total of 421 participants (60.1%) were followed up after 7.4 years as adolescents (ages, 12-23 years).

Outcomes were the apnea-hypopnea index (AHI) score, ascertained via polysomnography conducted in a laboratory; eBP measured in the seated position identified using guideline-recommended pediatric criteria; orthostatic hyperreactivity identified with BP assessed in the supine and standing positions; and visceral adipose tissue assessed via dual-energy x-ray absorptiometry.

-- Among the 421 participants (mean [SD] age at follow-up, 16.5 [2.3] years), 227 (53.9%) were male and 92 (21.9%) were racial/ethnic minorities.

-- A persistent AHI of 2 or more since childhood was longitudinally associated with adolescent eBP, while a remitted AHI of 2 or more was not.

-- Adolescent OSA was associated with eBP in a dose-response manner; however, the association of an AHI of 2 to less than 5 among adolescents was nonsignificant and that of an AHI of 5 or more was approximately 2-fold after adjusting for visceral adipose tissue.

-- An AHI of 5 or more, but not between 2 and less than 5, was associated with orthostatic hyperreactivity among adolescents even after adjusting for visceral adipose tissue.

-- Childhood OSA was not associated with adolescent eBP in female participants, while the risk of OSA and eBP was greater in male participants.

Conclusively, the results of this cohort study suggest that childhood OSA is associated with adolescent hypertension only if it persists during this developmental period. Visceral adiposity explains a large extent of, but not all, the risk of hypertension associated with adolescent OSA, which is greater in male individuals.