Sleep-disordered breathing and blood pressure in children: a meta-analysis.

OBJECTIVES: To estimate the risk of elevated blood pressure (BP) in children with obstructive sleep-disordered breathing (SDB) and to explore heterogeneity among published studies. DATA SOURCE: PubMed database. STUDY SELECTION: Pediatric cohort studies that investigated the relationship between SDB and BP. MAIN EXPOSURE: Level of severity of SDB. MAIN OUTCOME MEASURES: Elevated systolic and diastolic BP. RESULTS: During wakefulness, moderate to severe SDB was associated with 87% and 121% higher risk for elevated systolic and diastolic BP, respectively, compared with mild or no SDB, but the association was not statistically significant (random-effects odds ratio OR, 1.87; 95% confidence interval CI, 0.73-4.80; and random-effects OR, 2.21; 95% CI, 0.80-6.10, respectively). In terms of heterogeneity, reports of systolic BP were characterized by large heterogeneity (quantification heterogeneity metric I(2) = 53%), whereas studies recording diastolic BP had moderate heterogeneity (I(2) = 31%). During sleep, large heterogeneity was identified among studies regarding elevated systolic BP (I(2) = 54%), and the random-effects OR was 1.20 (95% CI, 0.29-5.02). No heterogeneity was detected regarding elevated diastolic BP (I(2) = 0%), although the fixed-effects OR was still not statistically significant (OR, 2.23; 95% CI, 0.61-8.16). CONCLUSIONS: No evidence exists that moderate to severe SDB in childhood increases the risk of elevated BP, and there is heterogeneity among published reports. Large and methodologically rigorous investigations are needed.