Effect of Sleep Disorders on Blood Pressure and Hypertension in Children
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PEDIATRIC HYPERTENSION (C HANEVOLD, SECTION EDITOR)
Effect of Sleep Disorders on Blood Pressure and Hypertension in Children Lourdes M. DelRosso 1 & Maria Paola Mogavero 2 & Raffaele Ferri 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review In this review, we aim to discuss the pathophysiologic basis of hypertension in sleep disorders and the current evidence in the medical literature linking sleep disorders and hypertension in children. Recent Findings The medical literature in adults is clear about the contribution of sleep disorders, poor sleep quality, and sleep deprivation to hypertension and increased cardiovascular risk. The literature on cardiovascular consequences of sleep disorders in children is not as robust, but there is some evidence of early cardiovascular changes in children with sleep deprivation and obstructive sleep apnea. Summary Children with obstructive sleep apnea have increased sympathetic activation during sleep, blunted dipping, or elevated systolic or diastolic pressures. Although the literature on other sleep disorders such as narcolepsy and restless legs syndrome is scarce, there is evidence in adults and some recent supportive data in children. Keywords Children sleep disorders . Obstructive sleep apnea sleep insufficiency . Hypertension
Introduction The overall prevalence of hypertension (HTN) in children is approximately 4.9% [1•], with higher prevalence in children with obesity (11%) [2], diabetes (8.5%) [3], and sleepdisordered breathing (14%) [4]. The most studied sleep disorder with cardiovascular consequences is undoubtfully obstructive sleep apnea (OSA). The adult medical literature is vast and demonstrates a clear association between the degree This article is part of the Topical Collection on Pediatric Hypertension * Lourdes M. DelRosso [email protected] Maria Paola Mogavero [email protected] Raffaele Ferri [email protected] 1
Pediatric Pulmonary and Sleep Medicine, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA
2
Istituti Clinici Scientifici Maugeri, IRCCS, Scientific Institute of Pavia, Via Salvatore Maugeri 4, 27100 Pavia, Italy
3
Sleep Research Centre, Oasi Research Institute—IRCCS, Via C. Ruggero 73, 94018 Troina, Italy
of OSA and hypertension. The pathophysiology has been proposed to include sympathetic activation and chronic inflammation secondary to the intermittent hypoxia following apneic episodes and nocturnal arousal. During the past decade, it has become increasingly clear that children with OSA are also at significant risk of developing elevated blood pressure and hypertension. In fact, the American Academy of Pediatrics (AAP) recommends for children with obstructive sleep apnea (OSA) to undergo evaluation of blood pressure regardless of OSA treatment status [5••]. The medical literature in adults has also made clear the contribution of other sleep disorders, poor sleep quality, and sleep deprivation to hypertension and increased cardiovascular risk. The literature o
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