Nocturnal blood pressure patterns in pediatric obstructive sleep apnea: The Kids Trial study

Obstructive sleep apnea (OSA) in children is associated with cardiovascular risk, but its impact on sleep blood pressure (BP) remains incompletely understood. Objective To assess the association between the severity of OSA, stratified by the obstructive apnea-hypopnea index (OAHI), and altered sleep BP patterns, specifically the non-dipping pattern (NDP), using ambulatory 24-h BP monitoring (ABPM). Methods The Kids-Trial is a multicenter observational trial (NCT03696654) conducted in Spain, including children with suspected OSA that underwent polysomnography for its diagnosis. To estimate the impact of OAHI on the risk of NDP, a multivariable logistic regression model was constructed and odds ratio (OR) was calculated. Results A total of 267 children were included (median age of 6 years and 42.7 % girls). When BP was assessed through z-score, significant positive trends were observed according to OSA severity in 24-h mean BP, 24-h systolic BP, sleep mean BP, sleep systolic BP, sleep diastolic BP, and NDP. A negative trend was observed for the drop in sleep mean BP. The adjusted model showed that severe OSA was independently associated with a reduced drop in mean BP (−3.68 (−6.9; −0.47); p = 0.026). Adjusted multivariable analysis of NDP showed an increased but not significant risk of NDP in severe OSA vs. non-OSA (OR = 2.76 (0.92, 8.30)). Conclusion Severe pediatric OSA was independently associated with disrupted nocturnal BP regulation, including a reduced BP dipping. These findings underscore the importance of ABPM in pediatric sleep evaluations. Clinical trial registration clinicaltrials.gov NCT03696654.