Association of Pediatric Obstructive Sleep Apnea With Elevated Blood Pressure and Orthostatic Hypertension in Adolescence
Association of Pediatric Obstructive Sleep Apnea With Elevated Blood Pressure and Orthostatic Hypertension in Adolescence
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DOI：
10.1001/jamacardio.2021.2003
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发表时间：
2021-06-23
期刊：
影响因子：
24
通讯作者：
Bixler, Edward O.
中科院分区：
文献类型：
--
作者：
Fernandez-Mendoza, Julio;He, Fan;Bixler, Edward O.
重要性尽管儿科指南已经描述了青年和成人指南中血压升高（eBP）的最新阈值，并且已经认识到阻塞性睡眠呼吸暂停（OSA）是eBP的既定危险因素，但是儿科OSA与青少年eBP的相关性仍然未被探索。在2000-2005年这项基于人群的队列研究（宾夕法尼亚州立大学儿童队列）的基线时，从普通人群中随机抽取700名5至12岁的儿童进行研究。2010-2013年，共有421名参与者（60.1%）在青少年（年龄，12-23岁）7.4年后接受随访。数据分析于2020年7月6日至10月29日进行。主要结局和指标结局为通过实验室多导睡眠图确定的呼吸暂停低通气指数（AHI）评分;使用指南推荐的儿科标准确定的坐位eBP;通过仰卧位和站立位血压评估确定的直立性高反应性;结果在421名参与者中（随访时平均[SD]年龄为16.5 [2.3]岁），227名（53.9%）为男性，92名（21.9%）为少数民族。从儿童期开始持续的AHI ≥ 2与青少年eBP纵向相关（比值比[OR]，2.9; 95%CI 1.1-7.5），而缓解的AHI ≥ 2则与青少年eBP纵向相关（OR，0.9; 95%CI 0.3-2.6）。青少年OSA与eBP呈剂量反应关系;然而，调整内脏脂肪组织后，青少年中AHI为2至小于5的相关性不显著（OR，1.5; 95%CI，0.9-2.6），而AHI为5或以上的相关性约为2倍（OR，2.3; 95%CI，1.1-4.9）。AHI ≥ 5（OR，3.1; 95%CI，1.2-8.5），但不介于2和小于5之间（OR，1.3; 95%CI，0.6-3.0），与青少年直立性高反应性相关，即使在调整内脏脂肪组织后也是如此。儿童OSA与青少年eBP在女性参与者，而OSA和eBP的风险更大，在男性participator.CONCLUSIONS和RELEVANCE-本队列研究的结果表明，儿童OSA与青少年高血压，只有当它持续在这个发展时期。内脏肥胖在很大程度上解释了与青少年OSA相关的高血压风险，但不是全部，这在男性个体中更大。
IMPORTANCE Although pediatric guidelines have delineated updated thresholds for elevated blood pressure (eBP) in youth and adult guidelines have recognized obstructive sleep apnea (OSA) as an established risk factor for eBP, the relative association of pediatric OSA with adolescent eBP remains unexplored.OBJECTIVE To assess the association of pediatric OSA with eBP and its orthostatic reactivity in adolescence.DESIGN, SETTING, AND PARTICIPANTS At baseline of this population-based cohort study (Penn State Child Cohort) in 2000-2005, a random sample of 700 children aged 5 to 12 years from the general population was studied. A total of 421 participants (60.1%) were followed up in 2010-2013 after 7.4 years as adolescents (ages, 12-23 years). Data analyses were conducted from July 6 to October 29, 2020.MAIN OUTCOMES AND MEASURES Outcomes were the apnea-hypopnea index (AHI) score, ascertained via polysomnography conducted in a laboratory; eBP measured in the seated position identified using guideline-recommended pediatric criteria; orthostatic hyperreactivity identified with BP assessed in the supine and standing positions; and visceral adipose tissue assessed via dual-energy x-ray absorptiometry.RESULTS Among the 421 participants (mean [SD] age at follow-up, 16.5 [2.3] years), 227 (53.9%) were male and 92 (21.9%) were racial/ethnic minorities. A persistent AHI of 2 or more since childhood was longitudinally associated with adolescent eBP (odds ratio [OR], 2.9; 95% CI 1.1-7.5), while a remitted AHI of 2 or more was not (OR, 0.9; 95% CI 0.3-2.6). Adolescent OSA was associated with eBP in a dose-response manner; however, the association of an AHI of 2 to less than 5 among adolescents was nonsignificant (OR, 1.5; 95% CI, 0.9-2.6) and that of an AHI of 5 or more was approximately 2-fold (OR, 2.3; 95% CI, 1.1-4.9) after adjusting for visceral adipose tissue. An AHI of 5 or more (OR, 3.1; 95% CI, 1.2-8.5), but not between 2 and less than 5 (OR, 1.3; 95% CI, 0.6-3.0), was associated with orthostatic hyperreactivity among adolescents even after adjusting for visceral adipose tissue. Childhood OSA was not associated with adolescent eBP in female participants, while the risk of OSA and eBP was greater in male participants.CONCLUSIONS AND RELEVANCE The results of this cohort study suggest that childhood OSA is associated with adolescent hypertension only if it persists during this developmental period. Visceral adiposity explains a large extent of, but not all, the risk of hypertension associated with adolescent OSA, which is greater in male individuals.