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Obstructive Sleep Apnea and Hypopnea in Hypertensive Obese Pediatric Patients

Brody School of Medicine at East Carolina University, Greenville, NC

PURPOSE: To evaluate if obstructive sleep apnea syndrome (OSAS) is a mechanism of hypertension in obese patients.

METHODS: Retrospective analysis of overnight polysomnography records of 90 pediatric patients aged 4.5 to 18.5 years. Obesity was expressed as BMI_score [body mass index (BMI) the 95^th percentile BMI]. The severity of systolic and diastolic hypertension are expressed as SBP_score (systolic BP the 95^th percentile systolic BP) and DBP_score (diastolic BP the 95^th percentile diastolic BP).

RESULTS: The incidence of hypertension (68%) and obesity (75%) was higher in patients with OSAS. Obese patients had a higher incidence of hypertension (70% vs. 9%), incidence of OSAS (54% vs. 29%), SBP_score (1.02±0.10 vs. 0.88±0.09), DBP_score (0.93±0.12 vs. 0.79±0.11), hypopnea index (HI) (3.83±6.20 vs. 0.89±1.54), and apnea-hypopnea index (AHI) (8.91±13.7 vs. 5.06±9.2) compared to non-obese patients (all p <0.05). In obese patients, SBP_score correlated with BMI_score (r = 0.33), Arousal Index (AI) (r = 0.32), and HI (r = 0.34). DBP_score correlated with BMI_score (r = 0.37), AI (r = 0.28), AHI (r = 0.4), and HI (r = 0.44). Multiple regression analysis was performed using BMI_score and log₁₀-transformed HI, AHI, and AI as independent predictors. Log₁₀HI (R² = 7%) and BMI_score (R² = 14%) were significant independent predictors of SBP_score. Log₁₀HI (R² = 18%) and BMI_score (R² = 10%) were significant independent predictors of DBP_score. Obese hypertensive patients (n=39) had a significantly higher HI (4.8±6.9 vs. 1.58±3.17), AHI (10.5±15.2 vs. 5.24±8.85), and incidence of OSAS (64% vs. 29%) than the obese normotensive patients (n=17).

CONCLUSIONS: Our findings are consistent with the hypothesis that OSAS is a mechanism of hypertension in obese pediatric patients.

CLINICAL IMPLICATION: Hypertensive obese patients should be screened for OSAS.

DISCLOSURE: R.M. Perkin, None.