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Published ahead of print on February 5, 2004, doi:10.1164/rccm.200309-1305OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 8, April 2004, 950-956

A more recent version of this article appeared on April 15, 2004
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Submitted on September 23, 2003
Accepted on February 4, 2004

Twenty-four Hour Ambulatory Blood Pressure in Children with Sleep Disordered Breathing

Raouf S Amin1*, John L Carroll2, Jenny L Jeffries1, Charles Grone1, Judy A Bean3, Barbara Chini1, Ronald Bokulic1, and Stephen R Daniels4

1 Pulmonary Medicine, Sleep Disorder Center, Cincinnati Children's Hospital Medical Center, University of Cinncinati College of Medicine, Cincinnati, OH, USA, 2 Pediatric Pulmonary Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA, 3 Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cinncinati College of Medicine, Cincinnati, OH, USA, 4 Cardiology, Cincinnati Children's Hospital Medical Center, University of Cinncinati College of Medicine, Cincinnati, OH, USA

* To whom correspondence should be addressed. E-mail: aminr0{at}chmcc.org.

Obstructive sleep apnea causes intermittent elevation of systemic blood pressure during sleep. To determine whether obstructive apnea in children has a tonic effect on diurnal blood pressure, twenty-four hour ambulatory blood pressure was obtained from 60 children with mean age of 10.8 ± 3.5 years. Thirty-nine children had obstructive apnea and 21 had primary snoring. Children with obstructive apnea had significantly greater mean blood pressure variability during wakefulness and sleep, a higher night-to-day systolic blood pressure and a smaller nocturnal dipping of mean blood pressure. Variability of mean arterial pressure during wakefulness was predicted by the desaturation, body mass and arousal indices while variability during sleep was predicted by apnea-hypopnea and body mass indices. Nocturnal blood pressure dipping was predicted by the desaturation index. There were no significant differences in systolic, diastolic or mean arterial blood pressure during sleep between the groups. Diastolic blood pressure during wakefulness was significantly different between the groups and correlated negatively with apnea-hypopnea index. We conclude that obstructive apnea in children is associated with twenty-four hour blood pressure dysregulation and that, independent of obesity, the frequency of obstructive apnea, oxygen desaturation and arousal contributes to abnormal blood pressure control.
Key words: Obstructive apnea, Ambulatory blood pressure, cardiovascular, child,




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