Li A M, Au C T, Sung R Y T, Ho C, Ng P C, Fok T F, Wing Y K
Dr A M Li, Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Thorax. 2008 Sep;63(9):803-9. doi: 10.1136/thx.2007.091132. Epub 2008 Apr 3.
Childhood obstructive sleep apnoea (OSA) is increasingly being recognised. Its effects on blood pressure (BP) elevation and hypertension are still controversial.
To evaluate the association between OSA and ambulatory BP in children.
Children aged 6-13 years from randomly selected schools were invited to undergo overnight sleep study and ambulatory BP monitoring after completing a validated OSA questionnaire. OSA was diagnosed if the obstructive apnoea-hypopnoea index (AHI) was >1, and normal controls had AHI <1 and snoring <3 nights per week. Children with OSA were subdivided into a mild group (AHI 1-5) and moderate to severe group (AHI >5).
306 subjects had valid sleep and daytime BP data. Children with OSA had significantly higher BP than normal healthy children during both sleep and wakefulness. BP levels increased with the severity of OSA, and children with moderate to severe disease (AHI >5) were at significantly higher risk for nocturnal systolic (OR 3.9 (95% CI 1.4 to 10.5)) and diastolic (OR 3.3 (95% CI 1.4 to 8.1)) hypertension. Multiple linear regression revealed a significant association between oxygen desaturation index and AHI with daytime and nocturnal BP, respectively, independent of obesity.
OSA was associated with elevated daytime and nocturnal BP, and is an independent predictor of nocturnal hypertension. This has important clinical implications as childhood elevated BP predicts future cardiovascular risks. Future studies should examine the effect of therapy for OSA on changes in BP.
儿童阻塞性睡眠呼吸暂停（OSA）越来越受到关注。其对血压升高和高血压的影响仍存在争议。
评估儿童OSA与动态血压之间的关联。
从随机选择的学校中邀请6至13岁的儿童，在完成一份经过验证的OSA问卷后，进行夜间睡眠研究和动态血压监测。如果阻塞性呼吸暂停低通气指数（AHI）>1，则诊断为OSA，正常对照组的AHI<1且每周打鼾<3晚。OSA患儿被分为轻度组（AHI 1-5）和中重度组（AHI>5）。
306名受试者有有效的睡眠和日间血压数据。OSA患儿在睡眠和清醒时的血压均显著高于正常健康儿童。血压水平随OSA严重程度增加而升高，中重度OSA（AHI>5）患儿夜间收缩压（OR 3.9（95%CI 1.4至10.5））和舒张压（OR 3.3（95%CI 1.4至8.1））高血压风险显著更高。多元线性回归显示，氧饱和度下降指数和AHI分别与日间和夜间血压存在显著关联，且独立于肥胖因素。
OSA与日间和夜间血压升高相关，是夜间高血压的独立预测因素。由于儿童期血压升高预示着未来的心血管风险，这具有重要的临床意义。未来的研究应探讨OSA治疗对血压变化的影响。
