Sleep Disorders | Sleep Review
From Sree Roy
I am happy to use this room again to draw your attention to a new scientific statement from the American Heart Association (AHA), which this time deals with sleep-related breathing disorders and cardiovascular diseases in children and adolescents.
The statement is meaningful because it means that more cardiologists, as well as more parents, are prepared – and may be more willing to treat cases of possible pediatric sleep apnea.
“Obstructive Sleep Apnea” [OSA] Affects 1-6% of all children and 30-60% of obese adolescents, so it’s more common in adolescents than people think, ”said Carissa M. Baker-Smith, MD, MD, MPH, MS, director of Pediatrics Preventive Cardiology at Nemours Children’s Hospital in Wilmington, Dela, and Associate Professor of Pediatric Cardiology at Sidney Kimmel Medical College, Thomas Jefferson University in Philadelphia, in a press release. “These sleep disorders can increase blood pressure and are also linked to insulin resistance and abnormal lipids – all of which can affect cardiovascular health in later years.”
The key points of the statement listed in the AHA and Nemours press releases are highlighted below. The full open access declaration is published in the Journal of the American Heart Association.
Children and adolescents with OSA may have elevated blood pressure, including a smaller-than-normal dip while sleeping, which is associated with a higher risk of cardiovascular events in adults. The statement suggests that pediatric OSA patients should have their blood pressure measured over a period of 24 hours in order to record waking and sleeping values.
Metabolic syndrome is another problem for children with even mild OSA (fewer than 2 episodes of breath pauses per hour). CPAP therapy can significantly lower triglyceride levels and improve high-density lipoprotein levels. Treatment for OSA can also improve metabolic syndrome factors, at least in the short term, although obesity status may be the primary cause of some metabolic factors.
“We need to raise awareness of how the rising prevalence of obesity can affect the quality of sleep in children and recognize sleep-related breathing disorders as something that could add to risks for high blood pressure and cardiovascular disease,” says Baker-Smith .
Sree Roy is the editor of Sleep Review.
The statement reiterates the recommendation by 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 suggesting a risk for pulmonary hypertension in children and adolescents who have long-term severe obstructive sleep apnea.
Says Baker-Smith, “What we learn about obstructive sleep apnea in children can benefit a future generation by producing heart-healthy children.”
Baker-Smith CM, Isaiah A, Melendres MC et al. Respiratory sleep disorders and cardiovascular disease in children and adolescents: a scientific opinion from the American Heart Association. J Am Heart Assoc. 08/18/2021; e022427. Online before printing.
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