Hypertension Clinical Trial
To identify the early effects of obstructive sleep apnea on the cardiovascular system of children.
BACKGROUND:
Obstructive sleep apnea (OSA) is an important clinical disorder occurring in men, women, and
children with a prevalence of 4 percent, 2 percent and 1-3 percent, respectively. OSA is
under active study in adults and is definitely linked with increased cardiovascular
morbidity, even in its mild to moderate clinical forms. In contrast, OSA has not been well
studied in children and the potential deleterious consequences on cardiovascular function
have received little or no attention.
DESIGN NARRATIVE:
The study will examine in children 1) The interaction between OSA and baroreflex
dysfunction, 2) The relation of OSA severity and baroreflex dysfunction to abnormalities in
blood pressure control during wakefulness and sleep, 3) The association of the diminished
baroreflex gain and impaired blood pressure control with an index of end organ damage, the
left ventricular mass index, and 4) Whether effective treatment of OSA results in
significant improvement in baroreceptor function, blood pressure control and a decrease in
left ventricular mass index. A cross-sectional study will be conducted in 8-12 year old
children with OSA and a matched group of normal children. Studies include baroreceptor
function, 24-hour ambulatory blood pressure and left ventricular mass index. Baroreceptor
function will be measured by non-invasive techniques based on combined computer analysis of
heart rate and blood pressure measured by portapres. 24-hour ambulatory blood pressure will
be measured by a Spacelab monitor and left ventricular mass index will be measured by direct
M-mode echocardiogram. A longitudinal study will be conducted on the effect of adequate
treatment of OSA on baroreceptor function, daytime and nocturnal blood pressure and left
ventricular mass index. A cohort of children with OSA and a matched group of normal controls
will be followed for a period of 12 months after treatment of the disorder. Results are
expected to show that children with OSA have decreased baroreceptor sensitivity, elevated
nocturnal blood pressure and increased left ventricular mass index and that effective
therapy for OSA, as determined by polysomnography, will improve or normalize baroreceptor
sensitivity as well as nocturnal blood pressures and will lead to a decrease in left
ventricular mass index.
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