High Blood Pressure In Children Linked With Sleep Breathing Problems

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High Blood Pressure In Children Linked With Sleep Breathing Problems

http://www.medicalnewstoday.com/medicalnews.php?newsid=53670

Children with high blood pressure may be at risk for sleep breathing

disorders, according to a small study reported at the American Heart

Association's 60th Annual Fall Conference of the Council for High

Blood Pressure Research.

In the study, 60 percent of hypertensive children had a condition

called sleep disordered breathing (SDB). SDB is characterized by

short periods of upper airway obstructions that are complete (apnea)

or partial (hypopnea), or a longer period of insufficient air

movement (obstructive hypoventilation).

" SDB is important because it can result in daytime sleepiness,

limited attention span, poor school performance, hyperactivity, poor

growth and increased blood pressure in the lungs, " said Alisa A.

Acosta, M.D., lead author of the study and a Fellow in pediatric

kidney disease and hypertension at the University of Texas Medical

School at Houston.

" We know there's a link in adults between obstructive sleep apnea --

the most common of the SDBs -- and high blood pressure, so we were

curious to see if the same link exists in our pediatric population, "

she said.

In obstructive sleep apnea (OSA), a person's airway repeatedly

collapses or partially collapses during sleep. This results in brief

periods of not breathing (apnea) followed by sudden attempts to

breathe. The sleep disruptions lead to daytime fatigue and reduced

cognitive performance. Another SDB, obstructive hypoventilation, is

inadequate breathing to meet the body's needs.

Risk factors for SDB in children include obesity and enlarged

tonsils. Some signs of SDB in a child include snoring, restless

sleep, morning headaches and excessive daytime sleepiness.

Researchers evaluated 15 boys and five girls (ages 4 to 18) with

primary hypertension who snored or had enlarged tonsils or night-time

high blood pressure. Each participated in a one-night sleep study.

High blood pressure in children is defined by a measurement greater

than the 95th percentile based on age, gender and height. Primary

hypertension is high blood pressure that's not linked to other causes

or conditions. About 1 percent to 3 percent of kids in the United

States have hypertension. In a previous study, the group found 3

percent to 4 percent of children and adolescents in Houston have

primary hypertension.

Of the 20 children, 11 had nighttime high blood pressure; 17 had

enlarged tonsils and adenoids; 18 were overweight (body mass index

greater than 85th percentile), and all had a history of snoring.

In the sleep study, researchers measured blood oxygen levels, airflow

rates, and brain activity to look for levels that would indicate

sleep disordered breathing.

Researchers found that 12 of the 20 children tested (60 percent) had

SDB: seven (35 percent) had obstructive sleep apnea (more than one

apnea episode per hour); four (20 percent) had obstructive

hypoventilation; and one (5 percent) had mild SDB. Of the remaining

eight children, six (30 percent) had a primary snoring disorder

without SDB, and two had a normal sleep pattern without snoring.

The prevalence of SDB in all children is 2 percent. In addition, 40

percent of children with enlarged tonsils and 46 percent of obese

children have SDB. In comparison, the current study of hypertensive

children shows 59 percent (10 patients) with enlarged tonsils and 65

percent (11 patients) with obesity had SDB.

" Hypertension appears to be an additional risk factor for SDB, and

further studies are needed to explore the relationship between the

two, " Acosta said.

Therapies for children with hypertension and SDB start with lifestyle

changes, Acosta said. " We stress therapeutic lifestyle changes such

as weight loss in all overweight kids and a low-salt diet. " The

children also need further evaluation by an ear, nose and throat

(ENT) specialist.

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Co-authors are Kathy Franco, R.N., B.S.N.; Monesha Gupta-Malhorta,

M.B.B.S.; . J. Castriotta, M.D.; and J. Portman, M.D.

The American Heart Association recommends that all children, age 3 or

older, have yearly blood pressure measurements.