Nocturnal blood pressure patterns in pediatric obstructive sleep apnea: The Kids Trial study

Abstract

Obstructive sleep apnea (OSA) in children is associated with cardiovascular risk, but its impact on sleep blood pressure (BP) remains incompletely understood. OBJECTIVE: To assess the association between the severity of OSA, stratified by the obstructive apnea-hypopnea index (OAHI), and altered sleep BP patterns, specifically the non-dipping pattern (NDP), using ambulatory 24-h BP monitoring (ABPM). METHODS: The Kids-Trial is a multicenter observational trial (NCT03696654) conducted in Spain, including children with suspected OSA that underwent polysomnography for its diagnosis. To estimate the impact of OAHI on the risk of NDP, a multivariable logistic regression model was constructed and odds ratio (OR) was calculated. RESULTS: A total of 267 children were included (median age of 6 years and 42.7 % girls). When BP was assessed through z-score, significant positive trends were observed according to OSA severity in 24-h mean BP, 24-h systolic BP, sleep mean BP, sleep systolic BP, sleep diastolic BP, and NDP. A negative trend was observed for the drop in sleep mean BP. The adjusted model showed that severe OSA was independently associated with a reduced drop in mean BP (-3.68 (-6.9; -0.47); p = 0.026). Adjusted multivariable analysis of NDP showed an increased but not significant risk of NDP in severe OSA vs. non-OSA (OR = 2.76 (0.92, 8.30)). CONCLUSION: Severe pediatric OSA was independently associated with disrupted nocturnal BP regulation, including a reduced BP dipping. These findings underscore the importance of ABPM in pediatric sleep evaluations. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov NCT03696654.