儿童阻塞性睡眠呼吸暂停 24 小时动态血压变异性。
24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea.
机构信息
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
出版信息
Laryngoscope. 2021 Sep;131(9):2126-2132. doi: 10.1002/lary.29455. Epub 2021 Feb 18.
OBJECTIVE
To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA).
STUDY DESIGN
Case series study.
METHODS
Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability.
RESULTS
A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status.
CONCLUSIONS
OSA in children is associated with increased BP and BP variability.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2126-2132, 2021.
目的
评估阻塞性睡眠呼吸暂停（OSA）儿童 24 小时动态血压监测中的血压变异性。
研究设计
病例系列研究。
方法
在一家三级医疗中心招募了年龄在 4 至 16 岁之间有临床症状的儿童。对每个儿童进行整夜多导睡眠图和 24 小时动态血压记录。OSA 的严重程度分为单纯打鼾（呼吸暂停低通气指数[AHI]＜1）、轻度 OSA（1≤AHI＜5）、中度 OSA（10＞AHI≥5）和重度 OSA（AHI≥10）。平均血压的标准差用作血压变异性的指标。
结果
共纳入 550 名儿童（平均年龄：7.6 岁；70%为男孩；20%为肥胖）。与单纯打鼾的儿童相比，重度 OSA 儿童的夜间收缩压（108.0 与 100.5mmHg，P＜0.001）、夜间舒张压（58.9 与 55.6mmHg，P=0.002）、夜间平均动脉压（75.3 与 70.5mmHg，P＜0.001）、夜间收缩压负荷（40.5%与 25.0%，P＜0.001）、夜间舒张压负荷（25.3%与 12.9%，P＜0.001）和夜间收缩压变异性（11.4 与 9.6，P=0.001）均显著更高。多元线性回归分析显示，在校正年龄、性别、肥胖和高血压状态后，AHI 与夜间收缩压变异性呈独立相关（回归系数为 0.31，95%CI 为 0.06-0.56，P=0.015）。
结论
儿童 OSA 与血压升高和血压变异性增加有关。
证据等级
4.喉镜，131：2126-2132，2021。
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