Top Things to Know: Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents
Published: August 18, 2021
- Risk factors for OSA in children and adolescents include overweight/obese status, premature birth, and adenotonsillar hypertrophy.
- Blood pressure (BP) elevations among children and adolescents with OSA may be best determined via ambulatory blood pressure assessment given the greater likelihood for nocturnal versus daytime hypertension.
- Children and adolescents with OSA have markers of MetS and markers of MetS have been shown to improve with treatment of OSA.
- Children and adolescents with OSA appear to have higher BP than controls during both sleep and wake times and BP levels increase with greater severity of OSA.
- Children with long-standing airway obstruction may be at greater risk for pulmonary hypertension (PHTN) and cor pulmonale.
- Clinicians should maintain a high degree of suspicion for the presence of OSA among children and adolescents. Degree of adenotonsillar hypertrophy (ATH) and clinical scores have not been shown to correlate well with severity of airway obstruction.
- Polysomnography (PSG) is the gold standard for diagnosis and disease severity stratification of upper airway obstruction.
- Children and adolescents at greatest risk for perioperative complications of adenotonsillectomy include those with severe OSA by PSG and those with severe OSA under 3 years of age with failure to thrive, obesity, cardiac involvement (e.g., right ventricular hypertrophy), Down syndrome, history of prematurity, craniofacial abnormalities, neuromuscular diseases, chronic lung disease and SCD. Careful peri-operative management is required.
- Children with OSA are most likely to experience greater CVD risk via the co-existence of obesity and/or future development of HTN and impaired glucose homeostasis. Treating physicians and providers are advised to take note of the potential risk for CVD posed by the presence of OSA versus merely determining whether OSA is present.
- Children with OSA should undergo weight assessment, in office and ambulatory blood pressure monitoring, given the risk for nocturnal hypertension and counseling regarding potential long-term CVD risk.
Citation
Baker-Smith CM, Isaiah A, Melendres MC, Mahgerefteh J, Lasso-Pirot A, Mayo S, Gooding H, Zachariah J; on behalf of the American Heart Association Athero, Hypertension, and Obesity in the Young Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Sleep-disordered breathing and cardiovascular disease in children and adolescents: a scientific statement from the American Heart Association. J Am Heart Assoc. 2021;10:e022427. DOI: 10.1161/JAHA.121.022427