Elsevier

The Journal of Pediatrics

Volume 155, Issue 3, September 2009, Pages 362-368.e1
The Journal of Pediatrics

Original Article
Blood Pressure is Elevated in Children with Primary Snoring

https://doi.org/10.1016/j.jpeds.2009.03.041Get rights and content

Objectives

To compare ambulatory blood pressure (ABP) in nonoverweight, prepubertal children with and without primary snoring (PS), and to investigate whether PS is a part of the dose-response relationship between sleep-disordered breathing (SDB) and BP in children.

Study design

This was a cross-sectional community-based study involving 190 children age 6 to 13 years. Each participant underwent an overnight sleep study and ABP monitoring after completing a validated sleep symptoms questionnaire. Individual systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial BP were calculated for wake and sleep periods. Subjects were hypertensive if mean SBP or DBP was > 95th percentile (relative to sex and height) of reference.

Results

A total of 56 nonsnoring controls, 46 children with PS, 62 children with an apnea-hypopnea index (AHI) of 1 to 3, and 26 children with an AHI > 3 were identified. The daytime and nighttime BP increased across the severity spectrum of SDB. The dose-response trends for the proportion of subjects with nighttime systolic and diastolic hypertension also were significant. Nighttime DBP was significantly higher in the children with PS compared with controls after adjusting for age, sex, and body mass index.

Conclusions

PS was demonstrated to be an aspect of the dose-response relationship between SDB and BP in children and should not be considered completely benign.

Section snippets

Methods

Subjects for this study were drawn from our childhood OSA epidemiologic study, which involved children age 6 to 13 years recruited from 13 schools chosen at random. Parents of these children were asked to complete a validated OSA screening questionnaire17 that stratified the children into high risk or low risk for OSA. Snoring frequency was included in the questionnaire with the following response options: never, less than 1 night per month, 1 to 2 nights per month, 1 to 2 nights per week, and

Results

A total of 619 subjects were admitted for PSG, but only 466 of them had completed the ABP recording. This was because 4 subjects were admitted for PSG every working day, but our unit only had 3 ABP recording machines. Thus, 3 of 4 subjects were randomly selected for recording, none of whom refused.

Of the 466 subjects who underwent both PSG and ABP recording, 190 nonoverweight prepubertal children (mean age, 10.0 ± 1.5 years) satisfied the inclusion criteria for this study and were included in

Discussion

Our findings demonstrate that PS is an aspect of the dose-response relationship between SDB and BP in our cohort of nonoverweight prepubertal children. Daytime and nighttime BP increased and nocturnal BP dipping decreased across the severity spectrum from no snoring to PS and to increasing OSA severity. This relationship remained statistically significant even after adjusting for age, sex, and BMI. The dose-response trends for the proportion of subjects with nighttime systolic and diastolic

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    Supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region (CUHK4161/02M) and a Direct Grant for Research from The Chinese University of Hong Kong (2007.1.074). The authors declare no conflicts of interest.

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