儿科睡眠门诊就诊患者中与高血压相关的危险因素：一项前瞻性队列研究。
Risk factors associated with hypertension in patients attending a pediatric sleep clinic: a prospective cohort study.
文献信息
| PMID | 42875603 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Esther Huimin Leow |
| 作者单位 | Paediatrics, Nephrology Service, KK Women's and Children's Hospital, Singapore, Singapore. Esther.Leow.H.M@singhealth.com.sg. |
| 期刊 | European journal of pediatrics |
| SCI 分区 | Q1 |
| IF | 3 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
未标注： 患有阻塞性睡眠呼吸暂停（OSA）的儿科患者由于多种因素的相互作用而面临高血压风险。诊断白大衣高血压（WCH）和隐匿性高血压（MH）需要进行24小时动态血压监测（ABPM）。然而，ABPM并非常规进行。我们旨在使用ABPM检测高血压，并识别与高血压相关的危险因素。这是一项前瞻性队列研究，纳入被转诊至睡眠门诊的儿科患者（5-18岁）。根据标准诊疗进行多导睡眠监测（PSG）或夜间脉搏血氧测定（OPO）。对所有招募的患者进行ABPM。主要结局是高血压，即动态高血压或MH。共招募68例患者。中位年龄为12.6（四分位距[IQR] 10.0-14.7）岁。14例（21%）未返回进行ABPM，10例（15%）读数不足。在其余44例具有完整ABPM数据的患者中，18/44例（41%）被诊断为高血压，其中10例（23%）为动态高血压，8例（18%）为MH。在18例高血压患者中，1例未进行睡眠研究；3/17例（18%）为原发性打鼾；6/17例（35%）、4/17例（24%）和4/17例（24%）分别为轻度、中度和重度OSA。轻度、中度、重度OSA和原发性打鼾患者中高血压的患病率分别为6/20（30%）、4/10（40%）、4/8（50%）和3/5（60%）。年龄（相对危险度[RR] 1.27，95%置信区间[CI] 1.07-1.52，p = 0.008）和原发性打鼾（RR 3.52，95% CI 1.38-8.97，p = 0.004）与高血压独立相关。
结论： 在睡眠门诊就诊的儿科患者中，年龄增长和原发性打鼾可能与高血压独立相关。需要更大规模的研究来验证这些危险因素。
已知： • 患有阻塞性睡眠呼吸暂停（OSA）的儿科患者有高血压风险，这通常由多种因素相互作用所致。• 诊断白大衣高血压（WCH）和隐匿性高血压（MH）需要进行24小时动态血压监测（ABPM）。
新发现： • 在这项前瞻性单中心研究中，对所有患者进行了ABPM，并根据美国心脏协会2022年儿童ABPM更新对高血压进行分类。• 在睡眠门诊就诊的儿科患者中，年龄增长和原发性打鼾与高血压独立相关。
英文摘要
UNLABELLED: Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension due to an interplay of factors. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH). However, ABPM is not routinely performed. We aim to detect hypertension using ABPM and to identify risk factors associated with hypertension. This was a prospective cohort study of pediatric patients (5-18 years of age) who had been referred to the sleep clinic. Polysomnography (PSG) or overnight pulse oximetry (OPO) were performed as per standard of care. ABPM was performed for all recruited patients. The primary outcome was hypertension, i.e., ambulatory hypertension or MH. Sixty-eight patients were recruited. Median age was 12.6 (interquartile range [IQR] 10.0-14.7) years. Fourteen (21%) did not return for the ABPM and ten (15%) had insufficient readings. Of the remaining 44 patients with complete ABPM data, hypertension was diagnosed in 18/44 (41%) with 10 (23%) having ambulatory hypertension and 8 (18%) having MH. Among the 18 patients with hypertension, one defaulted sleep study; 3/17 (18%) had primary snoring; 6/17 (35%), 4/17 (24%), and 4/17 (24%) had mild, moderate, and severe OSA, respectively. The prevalence of hypertension was 6/20 (30%), 4/10 (40%), 4/8 (50%), and 3/5 (60%) among patients with mild, moderate, and severe OSA and primary snoring, respectively. Age (relative risk [RR] 1.27, 95% confidence interval [CI] 1.07-1.52, p = 0.008) and primary snoring (RR 3.52, 95% CI 1.38-8.97, p = 0.004) were independently associated with hypertension.
CONCLUSION: Increasing age and primary snoring may be independently associated with hypertension among pediatric patients attending the sleep clinic. Larger studies will be required to validate these risk factors.
WHAT IS KNOWN: • Pediatric patients with obstructive sleep apnea (OSA) are at risk of hypertension which is often due to an interplay of multiple factors. • Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is required to diagnose white coat hypertension (WCH) and masked hypertension (MH).
WHAT IS NEW: • In this prospective single-center study, ABPM was performed for all patients, classifying hypertension based on the 2022 update on ABPM in children from the American Heart Association. • Increasing age and primary snoring were independently associated with hypertension in pediatric patients attending the sleep clinic.