AHA Calls Attention to Obstructive Sleep Apnea, Sleep-Disordered Breathing in Children

Carissa Baker-Smith, MD, MPH

The American Heart Association (AHA) is hoping to call attention to what they see as an often-overlooked issue related to cardiovascular health: the presence of sleep-disordered breathing and its association with cardiovascular disease in children and adolescents.

Published in the Journal of the American Heart Association, the latest scientific statement from the AHA provides an overview of the epidemiology, diagnosis, treatment options, and outcomes associated with sleep-disordered breathing and obstructive sleep apnea (OSA) in younger patients.

“The likelihood of children having disordered breathing during sleep and, in particular, obstructive sleep apnea, may be due to enlargement of the tonsils, adenoids or a child’s facial structure, however, it is important for parents to recognize that obesity also puts kids at risk for obstructive sleep apnea,” said statement writing group chair Carissa M. Baker-Smith, MD, MPH, MS, director of pediatric preventive cardiology at the Nemours Children’s Hospital in Wilmington, Delaware, and associate professor of pediatric cardiology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, in a statement from the AHA. “Sleep disruptions due to sleep apnea have the potential to raise blood pressure and are linked with insulin resistance and abnormal lipids, all of which may adversely impact overall cardiovascular health later in life.”

Published on August 18, the 17-page document is broken down into 6 sections, including clinical presentation in children and adolescents, diagnostic evaluation, cardiovascular complications, pulmonary hypertension, cor pulmonale, and sleep-disordered breathing, treatment and outcomes, and anesthesia risk and perioperative considerations in this patient population. Prepared on behalf of the AHA’s Atherosclerosis, Hypertension and Obesity in the Young subcommittee of the Council on Cardiovascular Disease in the Young, the statement’s writing group was comprised of 8 members and contained more than 160 references.

Among the primary objectives of the statement was to outline potential symptoms and risk factors associated with OSA or sleep-disordered breathing in younger patients. In the statement, the writing committee highlighted risk factors for OSA vary by age, but general risk factors include obesity, upper and lower airway disease, allergic rhinitis low muscle tone, enlarged tonsils and adenoids, craniofacial malformations and neuromuscular disorders. The writing committee also pointed out sickle cell disease has been reported as risk factor for OSA and being born premature could increase the risk of sleep-disordered breathing.

“Obesity is a significant risk factor for sleep disturbances and obstructive sleep apnea, and the severity of sleep apnea may be improved by weight loss interventions, which then improves metabolic syndrome factors such as insulin sensitivity,” Baker-Smith said. “We need to increase awareness about how the rising prevalence of obesity may be impacting sleep quality in kids and recognize sleep-disordered breathing as something that could contribute to risks for hypertension and later cardiovascular disease.”

The writing committee also listed multiple symptoms that could indicate presence of OSA in children, including habitual snoring, gaps or snorting noises while sleeping, labored breathing during sleep, sleeping in a seated position or with neck hyperextended, daytime sleepiness, headache upon waking, or signs of upper airway obstruction. The committee also reiterated the recommendation of the American Academy of Otolaryngology and Head and Neck Surgery, which purported polysomnography as the best avenue for diagnosing sleep-disordered breathing.

Although the statement outlined potential cardiovascular complications associated with OSA and sleep-disordered breathing, specifically the risk of hypertension, the writing committee highlighted the need for further research to better understand how OSA and sleep-disordered breathing might influence cardiovascular health later in life.

This statement, “Sleep-Disordered Breathing and Cardiovascular Disease in Children and Adolescents,” was published in the Journal of the American Heart Association.