Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study

Kate C Chan,1 Chun T Au,1 Michelle W Yu,1 Yun K Wing,2 Albert M Li1 1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; 2Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Ko...

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Autores principales:	Chan KC, Au CT, Yu MW, Wing YK, Li AM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	obstructive sleep apnea children epidemiology stage-dependent osa rapid eye movement phenotype blood pressure Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/696374a5bae34103b2dda68271cf382b
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spelling	oai:doaj.org-article:696374a5bae34103b2dda68271cf382b2021-12-02T18:10:29ZNatural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study1179-1608https://doaj.org/article/696374a5bae34103b2dda68271cf382b2021-11-01T00:00:00Zhttps://www.dovepress.com/natural-history-of-rem-osa-in-children-and-its-associations-with-adver-peer-reviewed-fulltext-article-NSShttps://doaj.org/toc/1179-1608Kate C Chan,1 Chun T Au,1 Michelle W Yu,1 Yun K Wing,2 Albert M Li1 1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; 2Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, ChinaCorrespondence: Albert M Li; Chun T AuDepartment of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative RegionTel +852-35052982; +852-35052917Fax +852-26360020Email albertmli@cuhk.edu.hk; junau@cuhk.edu.hkPurpose: Most respiratory events in childhood obstructive sleep apnea (OSA) take place during rapid-eye-movement (REM) sleep. This study aimed to describe the characteristics and natural history of childhood REM-OSA and to evaluate the associations between OSA subtypes and blood pressure (BP) outcomes.Participants and Methods: This was a prospective 10-year follow-up study of a cohort established for a childhood OSA epidemiologic study. All subjects from the original cohort were invited to undergo a polysomnography (PSG) and 24-hour ambulatory blood pressure (ABP) monitoring. REM-OSA was defined with a ratio of obstructive apnea hypopnea index (OAHI) during REM sleep (OAHIREM) to OAHI during non-REM sleep (OAHINREM) ≥ 2. Natural history was observed and linear mixed models were used to assess the associations between OSA subtypes and BP outcomes.Results: A total of 610 participants from baseline were included to study the epidemiology of REM-OSA in childhood. Among children with OSA, 65% had REM-OSA. At 10-year follow-up, 234 were included in the analysis. REM-OSA was more common at both baseline (58/92, 63%) and 10-year follow-up (34/58, 59%). For those with REM-OSA at baseline and persistent OSA at follow-up, the majority (72%) remained to have REM-OSA. Compared to those without OSA, subjects with REM-OSA had significantly higher nocturnal SBP (mean difference 2.19 mmHg, 95% confidence interval (CI): 0.12, 4.26; p = 0.039) and DBP (mean difference 1.58 mmHg, 95% confidence interval (CI): 0.11, 3.04; p = 0.035), and less nocturnal SBP dipping (mean difference − 1.84%, 95% CI: − 3.25, − 0.43; p = 0.011), after adjusting for potential confounders. This significant association between REM-OSA and nocturnal SBP dipping was observed at baseline visit only.Conclusion: REM-OSA was found to be a stable phenotype through childhood to young adulthood, and REM-OSA was associated with higher nocturnal BP and a lesser degree of nocturnal SBP dipping in children.Keywords: obstructive sleep apnea, children, epidemiology, stage-dependent OSA, rapid eye movement, phenotype, blood pressureChan KCAu CTYu MWWing YKLi AMDove Medical Pressarticleobstructive sleep apneachildrenepidemiologystage-dependent osarapid eye movementphenotypeblood pressurePsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 13, Pp 1967-1984 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	obstructive sleep apnea children epidemiology stage-dependent osa rapid eye movement phenotype blood pressure Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	obstructive sleep apnea children epidemiology stage-dependent osa rapid eye movement phenotype blood pressure Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Chan KC Au CT Yu MW Wing YK Li AM Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
description	Kate C Chan,1 Chun T Au,1 Michelle W Yu,1 Yun K Wing,2 Albert M Li1 1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; 2Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, ChinaCorrespondence: Albert M Li; Chun T AuDepartment of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, 6/F, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative RegionTel +852-35052982; +852-35052917Fax +852-26360020Email albertmli@cuhk.edu.hk; junau@cuhk.edu.hkPurpose: Most respiratory events in childhood obstructive sleep apnea (OSA) take place during rapid-eye-movement (REM) sleep. This study aimed to describe the characteristics and natural history of childhood REM-OSA and to evaluate the associations between OSA subtypes and blood pressure (BP) outcomes.Participants and Methods: This was a prospective 10-year follow-up study of a cohort established for a childhood OSA epidemiologic study. All subjects from the original cohort were invited to undergo a polysomnography (PSG) and 24-hour ambulatory blood pressure (ABP) monitoring. REM-OSA was defined with a ratio of obstructive apnea hypopnea index (OAHI) during REM sleep (OAHIREM) to OAHI during non-REM sleep (OAHINREM) ≥ 2. Natural history was observed and linear mixed models were used to assess the associations between OSA subtypes and BP outcomes.Results: A total of 610 participants from baseline were included to study the epidemiology of REM-OSA in childhood. Among children with OSA, 65% had REM-OSA. At 10-year follow-up, 234 were included in the analysis. REM-OSA was more common at both baseline (58/92, 63%) and 10-year follow-up (34/58, 59%). For those with REM-OSA at baseline and persistent OSA at follow-up, the majority (72%) remained to have REM-OSA. Compared to those without OSA, subjects with REM-OSA had significantly higher nocturnal SBP (mean difference 2.19 mmHg, 95% confidence interval (CI): 0.12, 4.26; p = 0.039) and DBP (mean difference 1.58 mmHg, 95% confidence interval (CI): 0.11, 3.04; p = 0.035), and less nocturnal SBP dipping (mean difference − 1.84%, 95% CI: − 3.25, − 0.43; p = 0.011), after adjusting for potential confounders. This significant association between REM-OSA and nocturnal SBP dipping was observed at baseline visit only.Conclusion: REM-OSA was found to be a stable phenotype through childhood to young adulthood, and REM-OSA was associated with higher nocturnal BP and a lesser degree of nocturnal SBP dipping in children.Keywords: obstructive sleep apnea, children, epidemiology, stage-dependent OSA, rapid eye movement, phenotype, blood pressure
format	article
author	Chan KC Au CT Yu MW Wing YK Li AM
author_facet	Chan KC Au CT Yu MW Wing YK Li AM
author_sort	Chan KC
title	Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
title_short	Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
title_full	Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
title_fullStr	Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
title_full_unstemmed	Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study
title_sort	natural history of rem-osa in children and its associations with adverse blood pressure outcomes: a longitudinal follow-up study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/696374a5bae34103b2dda68271cf382b
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_version_	1718378574247886848

Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study

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