Department of Pediatric Nephrology, "P. & A. Kyriakou" Children's Hospital, Thivon and Levadias St, 115 27, Athens, Greece.
Sleep Disorders Laboratory, Larissa University Hospital, Larissa, Greece.
Pediatr Nephrol. 2020 Aug;35(8):1491-1498. doi: 10.1007/s00467-020-04544-0. Epub 2020 Mar 30.
It is recommended that children with hypertension and loud snoring should be referred for polysomnography. We aimed to compare the frequency of moderate-to-severe obstructive sleep apnea syndrome (OSAS) among snorers with and without hypertension. Thus, it was hypothesized that systolic or diastolic hypertension among children with snoring is a risk factor for moderate-to-severe OSAS.
Data of children with snoring and adenotonsillar hypertrophy and/or obesity referred for polysomnography were retrospectively analyzed. Blood pressure (BP) was measured three times in the morning after polysomnography and percentiles were calculated for the average of the second and third measurement. Association of systolic or diastolic hypertension with moderate-to severe OSAS (apnea-hypopnea index-AHI > 5 episodes/h) adjusted for age and obesity was assessed by logistic regression.
Data of 646 children with snoring (median age, 6.5 years; 3-14.9 years; 25.7% obese) were analyzed. Prevalence of systolic or diastolic hypertension was 14.1% and 16.1%, respectively and frequency of AHI > 5 episodes/h was 18.3%. Systolic hypertension was a significant predictor of moderate-to-severe OSAS (OR 1.87; 95% CI 1.10 to 3.17; P = 0.02) after adjustment for age and obesity, but diastolic hypertension was not (OR, 0.96; 0.55 to 1.67; P > 0.05). Odds of AHI > 5 episodes/h prior to considering systolic hypertension was 0.25 and after considering its presence, increased to 0.46 (Bayes' theorem), or for every three children with systolic hypertension and snoring tested, one had AHI > 5 episodes/h.
In the context of systolic hypertension and snoring, referral for polysomnography to rule out moderate-to-severe OSAS is a clinically productive practice.
建议高血压和打鼾的儿童进行多导睡眠图检查。我们旨在比较打鼾伴有和不伴有高血压的儿童中中重度阻塞性睡眠呼吸暂停综合征（OSAS）的频率。因此，我们假设儿童打鼾时的收缩压或舒张压升高是中重度 OSAS 的危险因素。
回顾性分析因打鼾和腺样体扁桃体肥大和/或肥胖而接受多导睡眠图检查的儿童数据。多导睡眠图检查后，每天早上测量三次血压（BP），并计算第二次和第三次测量的平均值的百分位数。使用逻辑回归评估收缩压或舒张压升高与中重度 OSAS（呼吸暂停低通气指数-AHI>5 次/小时）的关联，调整年龄和肥胖因素。
分析了 646 例打鼾儿童（中位年龄 6.5 岁；3-14.9 岁；25.7%肥胖）的数据。收缩压或舒张压升高的患病率分别为 14.1%和 16.1%，AHI>5 次/小时的频率为 18.3%。收缩压升高是中重度 OSAS 的显著预测因素（OR 1.87；95%CI 1.10 至 3.17；P=0.02），但舒张压升高不是（OR 0.96；0.55 至 1.67；P>0.05）。在考虑收缩压升高之前，AHI>5 次/小时的可能性为 0.25，在考虑收缩压升高之后，可能性增加到 0.46（贝叶斯定理），即每三个患有收缩压升高和打鼾的儿童中，就有一个患有 AHI>5 次/小时。
在收缩压升高和打鼾的情况下，进行多导睡眠图检查以排除中重度 OSAS 是一种有临床意义的做法。
