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 10years 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 4.0questionnaire. 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.
Highlights
Obstructive sleep-disordered breathing is a common disorder in childhood, interfering with the patient's physical, cognitive, emotional and social development.[1]
Stepwise multiple regression analysis revealed that age, female sex, reflection coefficient and systolic volume were independent predictors of augmentation index
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
Summary
Obstructive sleep-disordered breathing (oSDB) is a common disorder in childhood, interfering with the patient's physical, cognitive, emotional and social development.[1] This term is used when symptoms are present, but without definition of the severity of airway obstruction assessed by objective methods such as polysomnography (PSG). The impacts of oSDB in children have received more attention. Studies have already shown that both isolated snoring and apneas are associated with worse quality of life, behavior, cognition and that children with oSDB have a two to three-fold increase in the use of health services.[6][7][8] Evidences of autonomic dysfunction have been reported, both during wake or sleep, as well as pressure changes and increased sympathetic activity in school-aged children and adolescents. Studies have already shown that both isolated snoring and apneas are associated with worse quality of life, behavior, cognition and that children with oSDB have a two to three-fold increase in the use of health services.[6][7][8] Evidences of autonomic dysfunction have been reported, both during wake or sleep, as well as pressure changes and increased sympathetic activity in school-aged children and adolescents. [9]
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