Sleep-Disordered Breathing and Blood Pressure in Children

Ζιντζαράς, Ηλίας; Kaditis, Athanasios G.

doi:10.1001/archpedi.161.2.172

Cited by 79 publications

(49 citation statements)

References 47 publications

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“…Our findings are in contrast to a recently published meta-analysis concluding there was no relationship between OSA in childhood and elevated BPs [25] . This analysis included only 5 papers with the vast majority of BP measurements performed during wakefulness.…”

Section: Discussioncontrasting

confidence: 99%

Hypertension and obstructive sleep apnea in Caucasian children

Kirk

Midgley²,

Giuffre³

et al. 2010

WJC

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AIM:To evaluate the prevalence of hypertension and/or left ventricular hypertrophy (LVH) in children with a diagnosis of obstructive sleep apnea (OSA). METHODS:A cross-sectional case series of consecutive, otherwise healthy children aged > 4 years, with polysomnography-proven OSA [apnea hypopnea index (AHI) > 1.5/h] is described. Echocardiography was performed on all subjects and left ventricular mass was calculated. Study subjects underwent additional investigation with 24-h ambulatory blood pressure (BP) monitoring. RESULTS:Thirty children (21 males) were studied.Mean age was 8.9 years. Mean body mass index was 19.87 kg/cm 2 . Mean AHI was 14.3/h. 10/30 (33%) of the study population met criteria for pre-hypertension (n = 3) or masked hypertension (n = 7) based on standard ambulatory monitoring criteria. All 10 children had systolic hypertension throughout the night with 5 of these also having elevated daytime systolic readings. There was a relationship between AHI and BP showing an increase of 1.162 percentile units in mean diastolic night BP (age, gender and height specific) per unit increase in AHI (P = 0.018). There were no subjects with LVH and/ or right ventricular hypertrophy. CONCLUSION:In our population of otherwise healthy Caucasian children, there was a high prevalence of hypertension that would not have been identified using standard office/clinic protocols.

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Section: Discussioncontrasting

confidence: 99%

Hypertension and obstructive sleep apnea in Caucasian children

Kirk

Midgley²,

Giuffre³

et al. 2010

WJC

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“…72 Studies demonstrating significant results are more likely to be published, especially in Englishlanguage indexed journals, as opposed to studies presenting negative findings, which are more likely to be published in a local journal, often nonindexed. 73 In this study, the effect of allele frequency and the effects of the dominant, recessive, and additive models were estimated. In addition, the consistency of genetic effects across populations from different ethnicities was investigated.…”

Section: Discussionmentioning

confidence: 99%

Endothelial nitric oxide synthase gene polymorphisms and diabetic nephropathy: A HuGE review and meta-analysis

Ζιντζαράς

Papathanasiou

Stefanidis

2009

Genetics in Medicine

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Candidate-gene association studies that examined the association between polymorphisms of endothelial nitric oxide synthase (NOS3) gene (G894T, 4b/a, and T786C) and diabetic nephropathy or diabetes leading to severe nephropathy produced inconclusive results. Thus, a meta-analysis of all candidate-gene association studies with endothelial nitric oxide synthase genotyping (7401 cases and 8046 controls) was conducted. Other study designs, such as family-based association studies and genome-wide linkage and association studies were also reviewed for supportive evidence of implication of endothelial nitric oxide synthase gene in diabetic nephropathy. The meta-analysis showed that G894T is significantly associated with diabetic nephropathy and diabetes leading to severe nephropathy in type 2 diabetics and in East Asians, respectively. Concerning the 4b/a polymorphism and its relationship to diabetes leading to severe nephropathy, a significant association was shown for East Asians. Heterogeneity between studies was in general high. There was no differential magnitude of effect in large versus small studies. One genome-wide linkage scan provided evidence of linkage nearby the endothelial nitric oxide synthase locus. Studies exploring gene and environment interactions with endothelial nitric oxide synthase polymorphisms may help understand better the genetics of diabetic nephropathy. Genet Key Words: eNOS, NOS3, G894T, 4b/a, T786C, diabetic nephropathy, diabetes, polymorphism, meta-analysis, genetic epidemiology Gene and gene variantsVascular endothelial nitric oxide (NO) regulates endothelial function and precipitates vasodilatory effects in multiple organs, including the kidney. 1 NO is produced by the oxidation of L-arginine to L-citrulline by NO synthase (NOS). There are three isoforms of NOS: endothelial NOS (eNOS), neuronal NOS, and inducible NOS. 2,3 Each isoform is coded by separate genes with a different pattern of expression. 4 The eNOS gene (NOS3) is located on chromosome 7q35-36, and it comprises 26 exons and 25 introns, with an entire length of 21kb. 4 Variants of eNOS gene contribute to endothelial dysfunction and attenuate the NO production. 5 Dysfunctional eNOS may play a critical role in the pathogenetic pathway, leading to diabetic vascular complications including diabetic nephropathy (DN). 6 Several polymorphisms of the eNOS gene have been identified, and their association with various diseases has been investigated, including coronary artery disease, myocardial infarction, coronary spasm, hypertension, end-stage renal disease (ESRD), and DN. 4,[7][8][9][10] The most clinically relevant polymorphisms that have been described in the eNOS gene 11 are the following: (i) a G894T substitution in exon 7 that results in a Glu to Asp substitution at codon 298, 7 (ii) an insertion-deletion in intron 4 consisting of two alleles (the a-deletion has 4 tandem 27-bp repeats, and the b-insertion has 5 repeats), 12 and (iii) a T786C substitution in the promoter region, which is strongly linked to 4b/a....

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“…Morbidity from the cardiovascular system a) A meta-analysis did not demonstrate an association between OSAS and blood pressure [78]. Four subsequent cross-sectional studies (class IV) identified a significant association [79][80][81][82], but one casecontrol study did not confirm this finding [83].…”

Section: Literature Reviewmentioning

confidence: 97%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Sleep-Disordered Breathing and Blood Pressure in Children

Abstract: No evidence exists that moderate to severe SDB in childhood increases the risk of elevated BP, and there is heterogeneity among published reports. Large and methodologically rigorous investigations are needed.

Cited by 79 publications

References 47 publications

Hypertension and obstructive sleep apnea in Caucasian children

Hypertension and obstructive sleep apnea in Caucasian children

Endothelial nitric oxide synthase gene polymorphisms and diabetic nephropathy: A HuGE review and meta-analysis

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

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