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. 2024 Feb 8;47(2):zsad254.
doi: 10.1093/sleep/zsad254.

Circadian blood pressure dysregulation in children with obstructive sleep apnea

Md Tareq Ferdous Khan  1   2 , David F Smith  3   4   5   6 , Christine L Schuler  4   7   8 , Abigail M Witter  8 , Mark W DiFrancesco  9   10 , Keren Armoni Domany  11   12 , Raouf S Amin  4   8 , Md Monir Hossain  1   4   8   13
Affiliations

Circadian blood pressure dysregulation in children with obstructive sleep apnea

Md Tareq Ferdous Khan et al. Sleep. .

Abstract

Study objectives: Obstructive sleep apnea (OSA) adversely affects normal blood pressure (BP) and may disrupt circadian BP patterns. We sought to examine 24-hour circadian BP rhythms in children with OSA and healthy controls.

Methods: Children 5-14 years with OSA and healthy controls underwent 24-hour BP monitoring and actigraphy to quantify sleep. Shape invariant statistical models compared circadian BP patterns (e.g. times of BP peaks, time arrived at peak BP velocity [TAPV]) in the OSA and control groups.

Results: The analytic sample included 219 children (mild OSA: n = 52; moderate-to-severe OSA (MS-OSA): n = 50; controls: n = 117). In the morning, the MS-OSA group had earlier TAPV for DBP than controls (51 minutes, p < 0.001). TAPV in the evening was earlier for the MS-OSA group than controls (SBP: 95 minutes, p < 0.001; DBP: 28 minutes, p = 0.028). At mid-day, SBP and DBP velocity nadirs were earlier for the MS-OSA group than controls (SBP: 57 minutes, p < 0.001; DBP: 38 minutes, p < 0.01). The MS-OSA group reached most BP values significantly earlier than controls; the largest differences were 118 minutes (SBP) and 43 minutes (DBP) (p < 0.001). SBP and DBP were elevated in the MS-OSA group (hours 18-21 and 7--12, respectively, p < 0.01) compared to controls. The MS-OSA group was prone to "non-dipping" compared to controls (SBP: odds ratio [OR] = 2.16, 95% CI: 1.09, 4.29; DBP: OR = 3.45, 95% CI: 1.21, 10.23).

Conclusions: Children with MS-OSA had changes in circadian BP patterns, namely earlier TAPV and BP peaks and nadirs than controls. Circadian disturbances in BP rhythms may be key to mapping the natural history of BP dysregulation in children with OSA.

Keywords: Circadian rhythms; ambulatory blood pressure monitoring; child; hypertension; obstructive sleep apnea.

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Conflict of interest statement

This project was totally federally funded. None of the investigators have relationships that may influence the findings and the conclusion described in the manuscript.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
The estimated 24-hour SBP and DBP velocity of control (solid line) and moderate-to-severe OSA (dotted line) groups are exhibited in panels A and B, respectively. The solid and dotted vertical lines indicate the times arrived at peak (or, nadir) velocity for control and moderate-to-severe OSA groups, respectively.
Figure 2.
Figure 2.
The estimated 24-hour SBP and DBP trajectories by OSA groups (control: solid line; and moderate-to-severe OSA: dotted line) are exhibited in panels A and B, respectively.
Figure 3.
Figure 3.
Error bar plots with mean ± SE of predicted SBP (A) and DBP (B) by control and moderate-to-severe OSA and children at every hour. At the top of each error bar, “*” indicates a significant P-value from testing the hourly difference between the control and moderate-to-severe OSA groups. Two-tailed t-tests were used to detect significant differences in the predicted hourly mean BPs.
See this image and copyright information in PMC

Comment in

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