Wu Yunxiao, Geng Xuezhi, Xu Zhifei, Ni Xin
Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
Department of infectious diseases, Tianjin Children's Hospital, Tianjin, People's Republic of China.
Nat Sci Sleep. 2022 Jul 15;14:1261-1271. doi: 10.2147/NSS.S370334. eCollection 2022.
To investigate the influence of obstructive sleep apnea (OSA) severity and weight on blood pressure (BP) during nighttime sleep in children.
Habitually snoring children who were 3-14 years old and from Beijing Children's Hospital between 1 January 2018 and 31 December 2020 were recruited. All participants completed polysomnography (PSG) and BP monitoring during different sleep stages using pulse transit time analysis. Subjects were divided into three groups based on the obstructive apnea-hypopnea index (OAHI), ie, primary snoring (PS), mild-to-moderate OSA, and severe OSA group.
Totally, 284 habitually snoring children were enrolled, including 85 with PS, 152 with mild-to-moderate OSA, and 47 with severe OSA. The differences of age and sex ratio among groups were not statistically significant (all >0.05). For the normal weight group, compared with those in the PS group, children in the severe OSA group had higher BP, mainly in N2 and R stages, and children in the mild-to-moderate OSA group had lower BP in all sleep and wake stages (all <0.01). For the overweight/obese group, compared with the PS group, children in the severe OSA group had higher BP in all sleep and wake stages, and children in the mild-to-moderate group had higher BP mainly in sleep stages (all <0.01). Compared with normal weight children, those who were overweight/obese and had OSA had higher BP in all sleep and wake stages (all <0.01). There was a synergistic effect of OSA and weight status on BP (<0.01).
The influence of OSA on both systolic and diastolic pediatric BP differs between children with normal weight and overweight/obese status. Overweight/obese status synergistically worsens nocturnal blood pressure in children with OSA. Early diagnosis and risk stratification are more important in overweight/obese children with OSA to achieve timely initiation of treatment.
探讨阻塞性睡眠呼吸暂停（OSA）严重程度和体重对儿童夜间睡眠期间血压（BP）的影响。
招募2018年1月1日至2020年12月31日期间来自北京儿童医院的3至14岁习惯性打鼾儿童。所有参与者均使用脉搏传输时间分析在不同睡眠阶段完成多导睡眠图（PSG）和血压监测。根据阻塞性呼吸暂停低通气指数（OAHI）将受试者分为三组，即原发性打鼾（PS）组、轻度至中度OSA组和重度OSA组。
共纳入284名习惯性打鼾儿童，其中PS组85名，轻度至中度OSA组152名，重度OSA组47名。各组间年龄和性别比例差异无统计学意义（均>0.05）。对于正常体重组，与PS组相比，重度OSA组儿童血压较高，主要在N2期和快速眼动（R）期，而轻度至中度OSA组儿童在所有睡眠和清醒阶段血压较低（均<0.01）。对于超重/肥胖组，与PS组相比，重度OSA组儿童在所有睡眠和清醒阶段血压较高，轻度至中度组儿童主要在睡眠阶段血压较高（均<0.01）。与正常体重儿童相比，超重/肥胖且患有OSA的儿童在所有睡眠和清醒阶段血压较高（均<0.01）。OSA和体重状态对血压有协同作用（<0.01）。
正常体重儿童和超重/肥胖儿童中，OSA对小儿收缩压和舒张压的影响有所不同。超重/肥胖状态会协同加重OSA患儿的夜间血压。对于超重/肥胖的OSA患儿，早期诊断和风险分层对于及时开始治疗更为重要。
