Comparisons of Office and 24-Hour Ambulatory Blood Pressure Monitoring in Children with Obstructive Sleep Apnea

Abstract

Objective: To compare office blood pressure (BP) and 24-hour ambulatory BP (ABP) monitoring to facilitate the diagnosis and management of hypertension in children with obstructive sleep apnea (OSA).

Study design: Children aged 4-16 years with OSA-related symptoms were recruited from a tertiary referral medical center. All children underwent overnight polysomnography, office BP, and 24-hour ABP studies. Multiple linear regression analyses were applied to elucidate the association between the apnea-hypopnea index and BP. Correlation and consistency between office BP and 24-hour ABP were measured by Pearson correlation, intraclass correlation, and Bland-Altman analyses.

Results: In the 163 children enrolled (mean age, 8.2 ± 3.3 years; 67% male). The prevalence of systolic hypertension at night was significantly higher in children with moderate-to-severe OSA than in those with primary snoring (44.9% vs 16.1%, P = .006). Pearson correlation and intraclass correlation analyses revealed associations between office BP and 24-hour BP, and Bland-Altman analysis indicated an agreement between office and 24-hour BP measurements. However, multiple linear regression analyses demonstrated that 24-hour BP (nighttime systolic BP and mean arterial pressure), unlike office BP, was independently associated with the apnea-hypopnea index, after adjustment for adiposity variables.

Conclusions: Twenty-four-hour ABP is more strongly correlated with OSA in children, compared with office BP.

Keywords: blood pressure; child; polysomnography; sleep apnea syndromes.