Division of Pediatric Nephrology and Hypertension, Department of Pediatrics.
Department of Pulmonary and Sleep Medicine.
Blood Press Monit. 2023 Jun 1;28(3):129-133. doi: 10.1097/MBP.0000000000000642. Epub 2023 Mar 14.
Obstructive sleep apnea (OSA) and hypertension are common complications in children with chronic kidney disease (CKD). Progression of CKD can aggravate OSA and hypertension whereas worsening sleep apnea can make hypertension difficult to treat in CKD patients. We, therefore, conducted a prospective study to evaluate the association between OSA and hypertension in pediatric patients with CKD.
In this prospective observational study consecutive children with CKD stage 3-5 (nondialysis dependent) underwent overnight polysomnography and 24-h ambulatory blood pressure monitoring (ABPM). The detailed clinical features and investigations were recorded in a prestructured performa.
Twenty-two children completed overnight polysomnography and 24-h ABPM was performed within 48 h of performing polysomnography. The median (IQR) age of the study population was 11 (8.5-15.5) years, with an age range of 5-18 years. Moderate-severe OSA defined as apnea-hypopnea index (AHI ≥5) was seen in 14 (63.6%) children, periodic limb movement syndrome in 20 (91%) and poor sleep efficacy in 9 (40.9%) children. Ambulatory blood pressure was abnormal in 15 (68.2%) children with CKD. Of them, 4 (18.2%) had ambulatory hypertension, 9 (40.9%) had severe ambulatory hypertension and 2 (9.1%) had masked hypertension. A statistically significant correlation of sleep efficiency with nighttime DBP SD score/Z score (SDS/Z) (r = -0.47; P = 0.02); estimated glomerular filtration rate with SBP loads (r = -0.61; P < 0.012); DBP loads (r = -0.63; P < ) and BMI with SBP load (r = 0.46; P = 0.012) was found.
Our preliminary findings suggest that ambulatory blood pressure abnormalities, OSA, periodic limb movement syndrome and poor sleep efficiency are highly prevalent in children with CKD stages 3-5.
阻塞性睡眠呼吸暂停（OSA）和高血压是慢性肾脏病（CKD）儿童常见的并发症。CKD 的进展会加重 OSA 和高血压，而睡眠呼吸暂停的恶化会使 CKD 患者的高血压难以治疗。因此，我们进行了一项前瞻性研究，以评估 CKD 患儿中 OSA 与高血压之间的关系。
在这项前瞻性观察研究中，连续纳入 CKD 3-5 期（非透析依赖）的患儿进行整夜多导睡眠图检查和 24 小时动态血压监测（ABPM）。详细的临床特征和检查结果记录在预先制定的表格中。
22 例患儿完成了整夜多导睡眠图检查，其中 24 小时 ABPM 在进行多导睡眠图检查后 48 小时内完成。研究人群的中位（IQR）年龄为 11（8.5-15.5）岁，年龄范围为 5-18 岁。14 例（63.6%）患儿存在中重度 OSA，定义为呼吸暂停低通气指数（AHI≥5）；20 例（91%）患儿存在周期性肢体运动障碍，9 例（40.9%）患儿睡眠效率差。15 例（68.2%）CKD 患儿的 ABPM 异常。其中，4 例（18.2%）存在 ABPM 高血压，9 例（40.9%）存在严重 ABPM 高血压，2 例（9.1%）存在隐匿性高血压。睡眠效率与夜间舒张压标准差/Z 评分（SDS/Z）呈显著相关（r=-0.47；P=0.02）；估计肾小球滤过率与 SBP 负荷（r=-0.61；P<0.012）；DBP 负荷（r=-0.63；P<）和 BMI 与 SBP 负荷（r=-0.46；P=0.012）呈负相关。
我们的初步研究结果表明，CKD 3-5 期患儿 ABPM 异常、OSA、周期性肢体运动障碍和睡眠效率差的发生率较高。
