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Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness

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Abstract

The association between obstructive sleep-disordered breathing (oSDB) and arterial stiffness, an independent predictor of cardiovascular outcomes, is not well established in children. This study compared cardiovascular parameters between healthy and oSDB children and aimed to identify predictors of arterial stiffness indices in children with oSDB. Cross-sectional study realized in a tertiary hospital from June 2018 to January 2020. Forty-eight children (3 to 10 years old) with clinical diagnosis of oSDB and indication for adenotonsillectomy and 24 controls were evaluated. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main arterial stiffness indices assessed were augmentation index and pulse wave velocity, both derived from the aortic pulse wave. In the oSDB group, the questionnaires Obstructive Sleep Apnea-18 (OSA-18) and Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) were applied. The oSDB group had higher values of reflection coefficient (p = 0.044) and augmentation index (p = 0.003) than the control group. Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient, and systolic volume were independent predictors of augmentation index. Higher pulse wave velocity values were associated with worse quality of life assessed by PedsQL 4.0 questionnaire. There was no association with OSA-18. The vascular and hemodynamic parameters were similar in both groups.

Conclusion: Children with oSDB have increased augmentation index, an independent predictor of cardiovascular outcomes. The early identification of subclinical cardiovascular changes reinforces the importance of treating the disease, as well as changing lifestyle habits, to prevent complications in adulthood.

What is Known:

• The association between oSDB and cardiovascular risk in adults is well described in the literature.

• Children with oSDB, regardless of their weight or sex, have higher PWV values when compared to non-snoring children.

What is New:

• Children with oSDB have augmented arterial stiffness, evidenced by the increase in AIx@75, measured non-invasively by brachial artery oscillometry with a portable device.

• Low quality of life and therefore a high disease burden in children with oSDB may be a risk factor for arterial stiffness.

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Abbreviations

AAO-HNS:

American Academy of Otolaryngology-Head and Neck Surgery

AIx@75:

Augmentation index normalized to heart rate of 75 bpm

AP:

Augmentation pressure

BMI:

Body mass index

cDBP:

Central diastolic blood pressure

CI:

Cardiac index

CO:

Cardiac output

cPP:

Central pulse pressure

cSBP:

Central systolic blood pressure

HR:

Heart rate

MAP:

Mean arterial pressure

OSA-18:

Obstructive Sleep Apnea-18 questionnaire

oSDB:

Obstructive sleep-disordered breathing

pDBP:

Peripheral diastolic blood pressure

PedsQL 4.0:

Pediatric Quality of Life Inventory, version 4.0

PPA:

Pulse pressure amplification (pPP/cPP ratio)

pPP:

Peripheral pulse pressure

pSBP:

Peripheral systolic blood pressure

PSG:

Polysomnography

PWV:

Pulse wave velocity

RC:

Reflection coefficient

SV:

Systolic volume

T&A:

Adenotonsillectomy

TVR:

Total vascular resistance

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Author information

Authors and Affiliations

  1. Post-Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais – FCM-MG, MG, Belo Horizonte, Brazil

    Eduardo Machado Rossi-Monteiro & Maria Glória Rodrigues-Machado

  2. Department of Otorhinolaryngology, Hospital Felício Rocho, Belo Horizonte, MG, Brazil

    Eduardo Machado Rossi-Monteiro, Laura Rodrigues Sefair, Marcos Correia Lima & Maria Fernanda Lima Nascimento

  3. Department of Vascular Surgery, Hospital Felício Rocho, Belo Horizonte, MG, Brazil

    Daniel Mendes-Pinto

  4. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland

    Lukas Anschuetz

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  1. Eduardo Machado Rossi-Monteiro
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  2. Laura Rodrigues Sefair
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  3. Marcos Correia Lima
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  7. Maria Glória Rodrigues-Machado
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Contributions

Rossi-Monteiro, EM: selected the patients; conceived and outlined the study; coordinated and supervised the data collection; analyzed and interpreted the data; drafted, edited, and critically reviewed the manuscript for important intellectual content. Sefair, LR; Lima, MC; Nascimento, MFL: contributed to the data collection and reviewed the manuscript for important intellectual content. Rodrigues-Machado, MG: conceived and designed the study; analyzed and interpreted the data; drafted, edited, and critically revised the manuscript for important intellectual content. Mendes-Pinto, D; Anschuetz, L: revised the manuscript for important intellectual content. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Maria Glória Rodrigues-Machado.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Bioethics Committee of the Faculdade Ciências Médicas de Minas Gerais under the protocol number 08812019000005134.

Consent to participate

Informed assent was obtained from all minors’ participants included in the study. Written informed consent was obtained from the parents or legal guardians.

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All parents or legal guardians have signed informed consent regarding publishing data about their children.

Competing interests

The authors declare no competing interests.

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Communicated by Peter de Winter

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Rossi-Monteiro, E.M., Sefair, L.R., Lima, M.C. et al. Pediatric obstructive sleep-disordered breathing is associated with arterial stiffness. Eur J Pediatr 181, 725–734 (2022). https://doi.org/10.1007/s00431-021-04238-1

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  • DOI: https://doi.org/10.1007/s00431-021-04238-1

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