Obstructive sleep apnea, a type of sleep disorder characterized by impaired breathing, may be linked to changes in blood pressure and heart structure in children and adolescents, according to a new scientific opinion.
The American Heart Association report urges parents and health care providers to consider testing children who have symptoms, are obese, or have enlarged tonsils, which puts them at higher risk.
It is estimated that up to 6% of all children and teenagers have obstructive sleep apnea, according to the statement published Wednesday in the Journal of the American Heart Association.
Symptoms of obstructive sleep apnea include habitual snoring, wheezing, snorting, or shortness of breath while sleeping, daytime sleepiness, sleeping while sitting with a bloated neck, headache on waking, and signs of upper airway obstruction. The condition commonly occurs in children with obesity. About 30% -60% of children who meet the criteria for obesity – with a body mass index in the 95th percentile or higher – also have sleep apnea.
“We need to raise awareness of how the rising prevalence of obesity can affect sleep quality in children and recognize sleep-related breathing disorders as something that could add to risks for high blood pressure and cardiovascular disease,” said Dr. Carissa M. Baker-Smith said in a press release. Baker-Smith is Director of Pediatric Preventive Cardiology at Nemours / Alfred I. duPont Hospital for Children in Wilmington, Delaware. She is also an Associate Professor of Pediatric Cardiology at Sidney Kimmel Medical College, Thomas Jefferson University in Philadelphia.
Obstructive sleep apnea is linked to cardiovascular disease in adults, but less is known about how the condition affects the immediate and long-term heart health of children and adolescents. A review of the most recent research included in the statement found evidence that it may affect emotional health, as well as the immune, metabolic, and cardiovascular systems in children and adolescents.
The risk factors for obstructive sleep apnea vary with age. In addition to obesity, they include upper and lower respiratory diseases; allergic rhinitis, inflammation and swelling of the nasal mucosa; low muscle tone; enlarged tonsils and polyps; craniofacial malformations; and neuromuscular disorders. Sickle cell anemia, an inherited blood disease, is also a risk factor.
Premature babies who have delayed development of breath control and smaller upper airways may also be at greater risk for sleep-related breathing disorders. However, this risk decreases with age.
The statement supports the recommendations of the American Academy of Otolaryngology and Head and Neck Surgery that sleep studies or polysomnographs are the best test for diagnosing sleep-related breathing disorders. Before a tonsillectomy, children should have this test if they have conditions that increase their risk of breathing complications during the operation. These include obesity, Down syndrome, craniofacial abnormalities such as a cleft palate, and conditions such as muscular dystrophy or sickle cell anemia.
Children and adolescents with obstructive sleep apnea may also have difficulty regulating blood pressure. While blood pressure usually drops during sleep, children with this condition see smaller drops than those without. Adults whose blood pressure does not drop while sleeping are at greater risk of cardiovascular events. For this reason, the statement calls for 24-hour blood pressure monitoring to check levels in children with sleep apnea.
Even mild cases of sleep apnea – defined as only two pauses in breathing per hour – are associated with a higher risk for metabolic syndrome in children. Metabolic syndrome is a collection of factors including high levels of insulin and triglycerides, high blood pressure, and low levels of high-density lipoprotein, or HDL, the “good” cholesterol. Continuous positive airway pressure, or CPAP, is a treatment for sleep apnea that delivers compressed air through a mask that can lower triglycerides and improve HDL levels.
Long-term, severe sleep apnea can also put children at increased risk of pulmonary hypertension if the pressure in the blood vessels from the heart to the lungs is too high. The opinion committee recommends that future research on how sleep apnea affects the risk of heart problems in children include 24-hour blood pressure monitoring and measurements of metabolic syndrome factors.