A recent review published in CHEST explored the available evidence pertaining to pathways that influence chronic cardiovascular risk in children with obstructive sleep apnea (OSA).

In a retrospective study reviewed, of 446 children who were referred to a hypertension clinic, 52% with severe OSA demonstrated stage 2 hypertension. Several other studies have reported higher systolic and diastolic blood pressure in children with OSA. In addition, as higher body mass indices (BMI) have been noted in children with OSA compared with children without OSA, multiple studies aimed to differentiate the effect of OSA vs BMI and found that each is independently linked to adverse CV events.

Other findings showed that treatment with adenotonsillectomy or continuous positive airway pressure (CPAP) was associated with blood pressure reduction in children with OSA, suggesting a causal relationship between high blood pressure  and OSA that should be further investigated in this population.1 Various studies have also reported links between endothelial dysfunction and OSA in children, and adenotonsillectomy led to improved endothelial function in children with OSA and no family history of hypertension.