By Sree Roy
I am happy to again use this space to draw attention to a new scientific statement from the American Heart Association (AHA), this time addressing sleep-disordered breathing and cardiovascular disease in children and adolescents.
The statement is significant because it means more cardiologists, as well as more parents, will be attuned to cases of possible pediatric sleep apnea—and may be more willing to treat it.
“Obstructive sleep apnea [OSA] affects 1-6% of all children and 30-60% of obese adolescents, so it is more common in youth than people think,” says statement writing group chair Carissa M. Baker-Smith, MD, MPH, MS, director of pediatric preventive cardiology at the Nemours Children’s Hospital in Wilmington, Dela, and associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, in a release. “These sleep disruptions can raise blood pressure and are also linked with insulin resistance and abnormal lipids—all of which can harm cardiovascular health in later years.”
Key points made in the statement, as detailed in releases from AHA and Nemours, are highlighted below. The full open-access statement is published in the Journal of the American Heart Association.
Children and adolescents with OSA may have higher blood pressure, including a smaller-than-normal dip while sleeping, which is linked with higher risk of cardiovascular events in adults. The statement suggests pediatric OSA patients have their blood pressure measured over a 24-hour period to capture waking and sleeping measurements.
Metabolic syndrome is another concern for children with even mild OSA (as few as 2 episodes of pauses in breathing per hour). CPAP therapy can significantly lower triglyceride levels and improve high-density lipoprotein levels. Treating OSA may also improve the factors of metabolic syndrome, at least in the short term, though obesity status may be the main reason for some metabolic factors.
“We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease,” Baker-Smith says.
The statement reiterates the recommendation of the American Academy of Otolaryngology and Head and Neck Surgery that polysomnography is the best test for diagnosing sleep-disordered breathing. It also outlines research that suggests a risk for pulmonary hypertension in children and adolescents that have long-term severe obstructive sleep apnea.
Baker-Smith says, “What we are learning about obstructive sleep apnea in children may benefit a future generation by creating heart-healthy kids.”
Baker-Smith CM, Isaiah A, Melendres MC, et al. Sleep-disordered breathing and cardiovascular disease in children and adolescents: a scientific statement from the American Heart Association. J Am Heart Assoc. 2021 Aug 18;e022427. Online ahead of print.