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    2017 Hinkle Abstract

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    Abdi Kebede
    1) The study characterized the prevalence of habitual snoring and obstructive sleep apnea (OSA) in children referred for high blood pressure (BP) to a pediatric hypertension clinic. 2) Of the 103 children who habitually snored, 95 met American Academy of Pediatrics guidelines for referral to be assessed for OSA but only 34 (36%) had been referred. 3) Of the 73 children who underwent polysomnography sleep studies, 56 (77%) were diagnosed with OSA and 21 (37.5%) had severe OSA. Severe OSA was associated with higher systolic BP.

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    2017 Hinkle Abstract

    Uploaded by

    Abdi Kebede
    35 views1 page
    1) The study characterized the prevalence of habitual snoring and obstructive sleep apnea (OSA) in children referred for high blood pressure (BP) to a pediatric hypertension clinic. 2) Of the 103 children who habitually snored, 95 met American Academy of Pediatrics guidelines for referral to be assessed for OSA but only 34 (36%) had been referred. 3) Of the 73 children who underwent polysomnography sleep studies, 56 (77%) were diagnosed with OSA and 21 (37.5%) had severe OSA. Severe OSA was associated with higher systolic BP.

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    1) The study characterized the prevalence of habitual snoring and obstructive sleep apnea (OSA) in children referred for high blood pressure (BP) to a pediatric hypertension clinic. 2) Of the 103 children who habitually snored, 95 met American Academy of Pediatrics guidelines for referral to be assessed for OSA but only 34 (36%) had been referred. 3) Of the 73 children who underwent polysomnography sleep studies, 56 (77%) were diagnosed with OSA and 21 (37.5%) had severe OSA. Severe OSA was associated with higher systolic BP.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    35 views1 page

    2017 Hinkle Abstract

    Uploaded by

    Abdi Kebede
    1) The study characterized the prevalence of habitual snoring and obstructive sleep apnea (OSA) in children referred for high blood pressure (BP) to a pediatric hypertension clinic. 2) Of the 103 children who habitually snored, 95 met American Academy of Pediatrics guidelines for referral to be assessed for OSA but only 34 (36%) had been referred. 3) Of the 73 children who underwent polysomnography sleep studies, 56 (77%) were diagnosed with OSA and 21 (37.5%) had severe OSA. Severe OSA was associated with higher systolic BP.

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    STRONG CHILDREN’S RESEARCH CENTER

    Summer 2017 Research Scholar

    Name: Jane Hinkle


    School: Cornell University
    Mentor: Marc Lande, MD, MPH
    ABSTRACT
    Title: Sleep Apnea in Children Referred for Elevated Blood Pressure

    Background: In adults, the comorbid relationship between obstructive sleep apnea (OSA) and
    elevated blood pressure (BP) is associated with increased risk of adverse cardiovascular
    outcomes and is predictive of the development of hypertension (HTN). In children, however, the
    relationship between OSA and elevated BP has yet to be well characterized. Studies have shown
    an association between OSA, behavioral problems and poor performance on neurocognitive
    examination in children. The American Academy of Pediatrics recommends that all children
    who are habitual snorers and exhibit comorbidities of OSA (e.g. overweight or hypertensive)
    undergo polysomnography or be referred to a sleep specialist or otolaryngologist (ENT) for
    evaluation of possible OSA.

    Objective: To characterize the prevalence of habitual snoring and OSA in children referred for
    high BP, to estimate the compliance of clinicians with the AAP guidelines, and to determine the
    impact of OSA on BP elevation, cognitive, and/or behavioral problems.

    Methods: A retrospective chart review of all consecutive new patients who attended the Pediatric
    Hypertension Clinic at the University of Rochester Medical Center between January 1st, 2013
    and December 31st, 2016. Patients with secondary HTN were excluded. All patients were asked
    about habitual snoring (loud, nightly snoring), learning disability (presence of learning disability
    associated IEP or 504 plan), ADHD (medication for inattention), and behavioral medication.
    Mean office BP was recorded as the average of 2-3 manual right arm BP readings. Charts were
    reviewed for echocardiogram and left ventricular hypertrophy (LVH). Subject medical records
    were examined for previous referral to ENT, or UR Pediatric Sleep Clinic. Polysomnography
    results were reviewed and OSA severity was categorized using Apnea Hypopnea Index (AHI).

    Results: Of 445 subjects who met the inclusion criteria, 103 had habitual snoring. Subjects with
    habitual snoring were more likely to have a higher BMI z-score (p<0.001), and Medicaid
    insurance (p=0.005). Of the habitual snorers, 95 were overweight, and therefore met AAP
    guidelines to be referred for assessment of OSA. Yet, only 34 (36%) had been previously referred
    for evaluation of OSA. Those previously referred had a higher average BMI z-score (p =0.04)
    and were more likely to have Medicaid insurance (p=0.02). In total, 73 individuals underwent
    polysomnography, and 56 (77%) were diagnosed with OSA, 21 (37.5%) with severe OSA. Those
    who received a diagnosis of OSA were not significantly different from those who did not in
    weight, BP, gender, age, or insurance. Of the subjects with severe OSA, 64.7% had BP in the
    stage two HTN range. These subjects had markedly higher systolic BP (p=0.014) than subjects
    with more mild cases of OSA, even when adjusted for age, sex, BMI z-score, and Medicaid
    status. Subjects with severe OSA had a higher prevalence of LVH, but this difference did not
    remain significant after controlling for BMI and BP. Subjects with severe OSA were not more
    likely to have cognitive or behavioral problems compared to subjects with milder OSA.

    Conclusion: The majority of children with habitual snoring who are referred for elevated BP are
    diagnosed with OSA following polysomnography (77%), and 37.5% with severe OSA. The
    severity of OSA cannot be predicted by clinical characteristics. Children with severe OSA have a
    striking prevalence of BP within the stage two HTN range.

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