Obstructive Sleep Apnea Persisting From Childhood to Adolescence Increases Risk for Hypertension

Mid adult female nurse measures the blood pressure of a young girl in a medical examination room
The researchers examined the links between pediatric obstructive sleep apnea (OSA) and elevated blood pressure and OSA’s orthostatic reactivity in adolescence.

Childhood obstructive sleep apnea (OSA) that persists during the developmental transition to adolescence is associated with increased risk for hypertension, according to results of a population-based cohort study, published in JAMA Cardiology.

Data from the Penn State Child Cohort, a 2-phase study, were analyzed. Participants (N=421) were assessed for 9 hours by polysomnography. Apneas and hypopneas were scored using the pediatric criteria for children younger than 16 years. Risk for hypertension was assessed on the basis of clinical and demographic features and OSA status.

Participants had a median age of 9 (range, 5-12) years at baseline and 16 (range, 12-23) years at follow-up, 53.9% were boys or men, 21.9% were members of racial or ethnic minorities, and 15.2% were obese (body mass index at the 95th percentile or higher).

Persistent apnea-hypopnea index (AHI) of at least 2 since childhood was increased among boys (odds ratio [OR], 3.7; 95% CI, 2.3-6.0; P <.001) and had a significant interaction with high blood pressure (BP; P =.03). AHI of 5 or more was associated with elevated BP (OR, 2.3; 95% CI, 1.0-5.0; P =.04).

Controlling for polysomnography or actigraphy variables, an AHI of 5 or more was associated with elevated BP (adjusted OR [aOR], 2.4; 95% CI, 1.2-5.1; P =.02), gluteofemoral adiposity (aOR, 2.5; 95% CI, 1.2-5.3; P =.02), and orthostatic hyper-reactivity (aOR, 3.9; 95% CI, 1.5-10.2; P =.005).

Overall rates of childhood OSA and high BP did not differ on the basis of gender, but OSA and high BP during adolescence were more common among boys than girls (47.6% vs 26.3%; P <.001; 39.6% vs 16.0%; P <.001, respectively). Boys were less likely to outgrow their childhood OSA (3.5% vs 9.8%; P <.001) and more likely to develop OSA (41.0% vs 21.6%; P <.001) compared with girls.

This study may have included some selection bias because only 60.1% participated in the follow-up assessment.

Childhood OSA that persisted during the transition to adolescence was associated with an almost 3-fold increased risk for future hypertension, especially among boys. Adipose tissue accounted for some but not all of the risk. These data suggested that children should been screened and monitored for OSA to prevent future cardiovascular disease.

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Fernandez-Mendoza J, He F, Calhoun SL, Vgontzas AN, Liao D, Bixler EO. Association of Pediatric Obstructive Sleep Apnea With Elevated Blood Pressure and Orthostatic Hypertension in Adolescence. JAMA Cardiol. 2021;e212003. doi:10.1001/jamacardio.2021.2003