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Baroreflex Gain in Children with Obstructive Sleep Apnea

¹ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ² Mayo Clinic, Rochester, Minnesota; and ³ Denver Children's Hospital, Denver, Colorado

Correspondence and requests for reprints should be addressed to Raouf Amin, M.D., 3333 Burnet Avenue, Cincinnati OH, 45229. E-mail: raouf.amin{at}cchmc.org

Rationale: We previously demonstrated that children with obstructive sleep apnea have increased blood pressure associated with changes in left ventricular mass index. Others have shown in adults that blood pressure variability is an important predictor of changes in left ventricular mass. The baroreflex system buffers blood pressure changes by varying heart rate. We have thus hypothesized that (1) baroreflex system gain is increased during sleep, improving blood pressure buffering; (2) children with obstructive sleep apnea lack this baroreflex gain increase; and (3) reduced blood pressure buffering results in exaggerated blood pressure variability that is associated with end-organ damage.

Objectives: Compare measures of left ventricular mass index and nighttime baroreflex gain of healthy children to those of children with obstructive sleep apnea.

Methods: A total of 169 children (50 control subjects, 63 with mild obstructive sleep apnea, and 56 with severe obstructive sleep apnea) with a mean age of 9.9 years (±2.2) underwent echocardiography followed by polysomnography with continuous blood pressure measurement. Baroreflex gain was calculated in time and frequency domains.

Measurements and Main Results: Healthy children demonstrated a nighttime pattern of increasing baroreflex gain. Children with obstructive sleep apnea had decreased nighttime baroreflex gain compared with control subjects. Nighttime blood pressure and blood pressure variability were significantly correlated with left ventricular mass index.

Conclusions: Obstructive sleep apnea is associated with a decrease in nighttime baroreflex gain and an increase in blood pressure variability. This increase is correlated with changes in left ventricular mass index.

Key Words: sleep • apnea • baroreceptor • blood pressure

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject The autonomic control of the cardiovascular system during sleep in children with sleep apnea has not been investigated. The associations between altered baroreceptor gain with abnormal control of blood pressure and with changes in cardiac geometry are not known. What This Study Adds to the Field Healthy children with obstructive sleep apnea have decreased baroreceptor gain. Blood pressure and blood pressure variability are directly related to increase in left ventricular mass.