Hypertension in Children with Obstructive Sleep Apnea Syndrome—Age, Weight Status, and Disease Severity
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Patient Selection
2.3. Measurements
2.3.1. Demographic and Anthropometric Variables
2.3.2. Polysomnography
2.3.3. Blood Pressure
2.4. Outcome Variables and Covariates
2.5. Statistical Analysis
3. Results
3.1. Demographic, Anthropometric, Polysomnographic, and Blood Pressure Characteristics
3.2. Differences in Clinical Variables between the Hypertensive and Normotensive Groups
3.3. Associations between Systolic Blood Pressure, Diastolic Blood Pressure, and Clinical Variables
3.4. Variables for Predicting Pediatric Hypertension
3.5. Variables Independently Associated with Hypertension in Obese and Non-Obese Children with OSAS Using Logistic Regression Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Hypertensive Group | Normotensive Group | p-Value |
---|---|---|---|
Patients | n = 107 | n = 289 | |
Blood pressure measures | |||
SBP z-score | 2.019 (1.258) | −0.250 (1.102) | <0.001 1 |
DBP z-score | 1.554 (1.178) | 0.317 (0.671) | <0.001 1 |
Demographic measures | |||
Sex | |||
Female, n (%) | 22 (19.3) | 92 (80.7) | 0.028 2 |
Male, n (%) | 85 (30.1) | 197 (69.9) | |
Age, years | 7.88 (3.01) | 7.36 (2.60) | 0.115 1 |
Development stage | |||
Toddler/preschooler, n (%) | 35 (24.8) | 106 (75.2) | 0.046 3 |
Early childhood, n (%) | 29 (21.2) | 108 (78.8) | |
Late childhood/adolescence, n (%) | 43 (36.4) | 75 (63.6) | |
Anthropometric measures | |||
Weight z-score | 1.066 (1.486) | 0.362 (1.458) | <0.001 1 |
Height z-score | 0.345 (1.133) | 0.102 (1.166) | 0.064 1 |
BMI z-score | 1.088 (1.459) | 0.429 (1.434) | <0.001 1 |
Obesity | |||
Non-obesity, n (%) | 58 (20.4) | 227 (79.6) | <0.001 2 |
Obesity, n (%) | 62 (55.9) | 49 (44.1) | |
Polysomnographic measures | |||
AHI, events/h | 20.59 (21.50) | 13.37 (17.72) | 0.003 1 |
Disease severity | |||
Mild OSAS, n (%) | 29 (20.9) | 110 (79.1) | <0.001 3 |
Moderate OSAS, n (%) | 13 (14.9) | 74 (85.1) | |
Severe OSAS, n (%) | 65 (38.2) | 105 (61.8) | |
Mean SpO2, % | 95.15 (3.18) | 96.01 (2.85) | 0.015 1 |
Abnormal SpO2 | |||
Normal SpO2, n (%) | 76 (23.5) | 247 (76.5) | 0.001 2 |
Abnormal SpO2, n (%) | 31 (42.5) | 42 (57.5) | |
Minimal SpO2, % | 83.02 (11.39) | 86.32 (8.00) | 0.007 1 |
Significant hypoxemia | |||
Non-significant hypoxemia, n (%) | 61 (23.1) | 203 (76.9) | 0.013 2 |
Significant hypoxemia, n (%) | 46 (34.8) | 86 (65.2) | |
Family history of hypertension | |||
Absence, n (%) | 89 (25.9) | 254 (74.1) | 0.221 2 |
Presence, n (%) | 18 (34.0) | 35 (66.0) | |
Family history of OSAS | |||
Absence, n (%) | 106 (27.2) | 283 (72.8) | 0.680 4 |
Presence, n (%) | 1 (14.3) | 6 (85.7) | |
Family history of obesity | |||
Absence, n (%) | 104 (26.6) | 287 (73.4) | 0.125 4 |
Presence, n (%) | 3 (60.0) | 2 (40.0) |
Predictors | Regression Coefficient (95% CI) | p-Value 1 | Regression Coefficient (95% CI) | p-Value 1 |
---|---|---|---|---|
Full model | Parsimonious model | |||
Systolic blood pressure z-score | ||||
Weight z-score | 0.27 (0.17–0.37) | <0.001 | 0.27 (0.18–0.37) | <0.001 |
AHI, events/h | 0.01 (−0.01–0.02) | 0.314 | 0.01 (0.001–0.02) | 0.043 |
Mean SpO2, % | −0.002 (−0.07–0.06) | 0.959 | NI 2 | |
Minimal SpO2, % | −0.01 (−0.03–0.02) | 0.505 | NI 2 | |
Model summary | R2 = 0.095 | R2 = 0.090 | ||
Diastolic blood pressure z-score | ||||
Weight z-score | 0.06 (−0.01–0.12) | 0.100 | NI 2 | |
AHI, events/h | 0.003 (−0.004–0.01) | 0.401 | NI 2 | |
Minimal SpO2, % | −0.01 (−0.02–0.01) | 0.210 | −0.02 (−0.03–−0.01) | 0.005 |
Model summary | R2 = 0.029 | R2 = 0.020 |
Predictors | Odds Ratio (95%CI) | p-Value 1 |
---|---|---|
Sex | ||
Female | reference | |
Male | 1.80 (1.06–3.07) | 0.029 |
Developmental stage | ||
Toddler/preschooler | reference | |
Early childhood | 0.81 (0.46–1.42) | 0.470 |
Late childhood/adolescence | 1.74 (1.02–2.97) | 0.043 |
Obesity | ||
Non-obesity | reference | |
Obesity | 3.09 (1.93–4.96) | <0.001 |
Disease severity | ||
Mild OSAS | reference | |
Moderate OSAS | 0.67 (0.33–1.37) | 0.267 |
Severe OSAS | 2.35 (1.41–3.92) | 0.001 |
Abnormal SpO2 | ||
Normal SpO2 | reference | |
Abnormal SpO2 | 2.40 (1.41–4.08) | 0.001 |
Significant hypoxemia | ||
Non-significant hypoxemia | reference | |
Significant hypoxemia | 1.78 (1.13–2.82) | 0.014 |
Family history of hypertension | ||
Absence | reference | |
Presence | 1.47 (0.79–2.72) | 0.223 |
Family history of OSAS | ||
Absence | reference | |
Presence | 0.45 (0.05–3.74) | 0.456 |
Family history of obesity | ||
Absence | reference | |
Presence | 4.14 (0.68–25.1) | 0.123 |
Predictors | Odds Ratio (95%CI) | p-Value 1 | Odds Ratio (95%CI) | p-Value 1 |
---|---|---|---|---|
Full model | Parsimonious model | |||
Female sex | reference | |||
Male sex | 1.61 (0.91–2.82) | 0.101 | NI 2 | |
Toddler/preschooler/early childhood | reference | reference | ||
Late childhood/adolescence | 1.67 (1.02–2.74) | 0.044 | 1.72 (1.05–2.81) | 0.031 |
Non-obesity | reference | reference | ||
Obesity | 2.58 (1.51–4.07) | <0.001 | 2.58 (1.58–4.22) | <0.001 |
Non-severe OSAS | reference | reference | ||
Severe OSAS | 1.99 (1.20–3.32) | 0.008 | 2.38 (1.48–3.81) | <0.001 |
Normal SpO2 | reference | |||
Abnormal SpO2 | 1.70 (0.93–3.11) | 0.084 | NI 2 |
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Chuang, H.-H.; Hsu, J.-F.; Wang, C.-Y.; Chuang, L.-P.; Chen, M.-C.; Chen, N.-H.; Huang, Y.-S.; Li, H.-Y.; Lee, L.-A. Hypertension in Children with Obstructive Sleep Apnea Syndrome—Age, Weight Status, and Disease Severity. Int. J. Environ. Res. Public Health 2021, 18, 9602. https://doi.org/10.3390/ijerph18189602
Chuang H-H, Hsu J-F, Wang C-Y, Chuang L-P, Chen M-C, Chen N-H, Huang Y-S, Li H-Y, Lee L-A. Hypertension in Children with Obstructive Sleep Apnea Syndrome—Age, Weight Status, and Disease Severity. International Journal of Environmental Research and Public Health. 2021; 18(18):9602. https://doi.org/10.3390/ijerph18189602
Chicago/Turabian StyleChuang, Hai-Hua, Jen-Fu Hsu, Chao-Yung Wang, Li-Pang Chuang, Min-Chi Chen, Ning-Hung Chen, Yu-Shu Huang, Hsueh-Yu Li, and Li-Ang Lee. 2021. "Hypertension in Children with Obstructive Sleep Apnea Syndrome—Age, Weight Status, and Disease Severity" International Journal of Environmental Research and Public Health 18, no. 18: 9602. https://doi.org/10.3390/ijerph18189602