Published online before print October 6, 2008, doi: 10.1161/HYPERTENSIONAHA.108.118083
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(Hypertension. 2008;52:807.)
© 2008 American Heart Association, Inc.
Editorial Commentaries |
Sleep-Disordered Breathing and Blood Pressure in Children
From the Department of Medicine, Medical University of South Carolina, Charleston.
Correspondence to Brent M. Egan, Medical University of South Carolina, 135 Rutledge Ave, RT 1230, Charleston, SC 29425. E-mail eganbm{at}musc.edu
The article by Bixler et al in this edition of Hypertension1 adds to a growing body of evidence that risk factors associated with abdominal obesity in adults, namely, sleep-disordered breathing (apnea-hypopnea), occur in children as well. Specifically, sleep-disordered breathing appeared to be more strongly associated with waist circumference, a surrogate marker for abdominal obesity, than with body mass index, a more generalized or global obesity marker. Although body mass index in children and youth is strongly related to prevalent metabolic syndrome,2 other data show that waist circumference is as good as,3 if not better than,4 body mass index as a predictive factor for metabolic syndrome at early ages. In adults, prevalent and incident sleep-disordered breathing are associated with body mass index.5,6
On a positive note, the prevalence of moderate sleep-disordered breathing in children, which was associated with a major effect on systolic blood pressure of >10 mm Hg, is relatively uncommon at 
1%. Although mild sleep-disordered breathing was identified in 25% of children, the systolic blood pressure effect was a more modest 2 mm Hg. Despite the lesser current blood pressure concern for the 25% of children with mild sleep-disordered breathing, evidence from the Bogalusa Heart Study indicates that children with greater levels of blood pressure and other metabolic syndrome risk factors also have a steeper trajectory of increasing risk factor values over time than children with lesser risk.7 Thus, future studies in children to examine changes in the apnea-hypopnea index, as well as metabolic syndrome risk factors over time, would be of interest.
Also of note in the report by Bixler et al1 is the observation that snoring and sleep-disordered breathing were related to blood pressure independent of age and waist circumference in multivariate regression modeling. In adults, sleep-disordered breathing is associated with hypertension independently of both body mass index and waist:hip ratio.8 In this regard, it should be noted that waist circumference but not body mass index was included in the multivariate regression in Table 4 of the report. Thus, it is not clear whether the association of sleep-disordered breathing with blood pressure in children is independent of both waist circumference and body mass index. Even without further studies, the current report adds to the weight of evidence that health risks associated with abdominal obesity begin early in life, and primary prevention should begin even earlier.
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Acknowledgments |
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Disclosures
None.
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Footnotes |
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The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.
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References |
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 Top References |
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1. Bixler EO, Vgontzas AN, Lin H-M, Liao D, Calhoun S, Fedok F, Vlasic V, Graff G. Blood pressure associated with sleep-disordered breathing in a population sample of children. Hypertension. 2008; 52: 841–846.
2. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Sayoe M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004; 350: 2362–2374.
3. Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics. 2004; 114: e198–e205.
4. Moreno LA, Pineda I, Rodriguez G, Fleta J, Sarria A, Bueno M. Waist circumference for the screening of metabolic syndrome in children. Acta Paediat. 2002; 91: 1307–1312.[CrossRef][Medline] [Order article via Infotrieve]
5. Young T, Shahar E, Nieto FJ, Redline S, Newman AB, Gottlieb DJk, Walsleben JA, Finn L, Enright P, Samet JM. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002; 162: 893–900.
6. Tishler PV, Larkin EK, Schluchter MD, Redline S. Incidence of sleep-disordered breathing in an urban adult population. JAMA. 2003; 289: 2230–2237.
7. Srinivasan SR, Myers L, Berenson GS. Changes in metabolic syndrome variables since childhood in prehypertensive and hypertensive subjects: the Bogalusa Heart Study. Hypertension. 2006; 48: 33–39.
8. Nieto FJ, Young TB, Lilnd BK, Shahar E, Samet JM, Redline S, D'Agostino RB, Newman AB, Lebowitz MD, Pickering TG. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. JAMA. 2000; 283: 1829–1836.
Related Article:
Hypertension 2008 52: 841-846.
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