Wu and Kabat 1970: A Transforming View of Antibody Diversity

Abstract

Blood pressure elevation is an OSAS-associated morbidity which is apparent mostly in children with apnea-hypopnea index (AHI)&gt;5 episodes/h (moderate-to-severe OSAS). We aimed to evaluate systolic or diastolic hypertension (≥95th percentile for age, gender and height; <i>Pediatrics</i> 2004;114:555) as predictors of AHI&gt;5 in children with snoring. <b>Methods:</b> Retrospective cohort of children aged ≥5 years with snoring and adenotonsillar hypertrophy and/or obesity who were referred for polysomnography (PSG) over 10 years. Blood pressure (BP) was measured X3 in the morning after polysomnography and percentiles were calculated for average systolic and diastolic BP. Logistic regression was applied to assess the association of systolic or diastolic hypertension with AHI&gt;5 adjusted for body mass index z-score and age. <b>Results:</b> Data of 598 children with snoring (median age 6.6 years;range 5-15.1;26.8% obese) were analyzed. Prevalence of systolic or diastolic hypertension was 9.4% and 8.4%, respectively and frequency of AHI&gt;5 was 16.7%. Systolic hypertension was a significant predictor of moderate-to-severe OSAS (OR 2.1; 95% CI 1.1-4.1;P=0.02), but diastolic hypertension was not (OR 1.2; 0.6-2.5; P&gt;0.05). The odds of AHI&gt;5 prior to considering systolic hypertension was 0.20 and after considering its presence increased to 0.40 (Bayes9 theorem), i.e. for every 6 children with snoring undergoing PSG, 1 had AHI&gt;5, while for every 4 children with systolic hypertension and snoring tested, 1 was found to have AHI&gt;5. <b>Conclusion:</b> In the context of systolic hypertension and snoring in an otherwise healthy child, referral for PSG to rule out moderate-to-severe OSAS seems to be clinically appropriate.