Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing

Raouf Amin, Virend K. Somers, Keith McConnell, Paul Willging, Charles Myer, Marc Sherman, Gary McPhail, Ashley Morgenthal, Matthew Fenchel, Judy Bean, Thomas Kimball, Stephen Daniels

Research output: Contribution to journalArticlepeer-review

202 Scopus citations

Abstract

Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.

Original languageEnglish (US)
Pages (from-to)84-91
Number of pages8
JournalHypertension
Volume51
Issue number1
DOIs
StatePublished - Jan 2008

Keywords

  • Ambulatory blood pressure
  • Blood pressure load
  • Blood pressure surge
  • Cardiac remodeling
  • Children
  • Hypertrophy
  • Sleep apnea

ASJC Scopus subject areas

  • Internal Medicine

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