Childhood Obstructive Sleep Apnea and Systemic Blood Pressure and Kidney Function: A Systematic Review and Meta‐Analysis

Background: Obstructive sleep apnea (OSA) is a recognized risk factor for high blood pressure (BP) and chronic renal dysfunction in adults. However, it remains uncertain whether a similar association exists in children. Objectives: This study assessed the associations between childhood OSA and systemic BP and renal outcomes. Additionally, it examined the effects of OSA treatments on BP in children. Methods: A systematic literature search was conducted to identify relevant studies up to August 2024. Results: Sixty‐four studies, consisting of 44 observational studies and 20 OSA interventional studies, were included. Compared with healthy control groups, children with OSA had significantly higher daytime systolic BP (3.30 mmHg; 95% CI, 2.07–4.53), daytime diastolic BP (1.27 mmHg; 95% CI, 0.69–1.84), nighttime systolic BP (4.08 mmHg; 95% CI, 2.71–5.46), nighttime diastolic BP (2.12 mmHg; 95% CI, 0.96–3.27), daytime mean arterial pressure (MAP) (2.11 mmHg; 95% CI, 1.32–2.89), and nighttime MAP (3.60 mmHg; 95% CI, 1.11–6.09). Obesity was the only other contributing factor to daytime systolic BP elevation. Meta‐analysis of studies on BP change after treatment (adenotonsillectomy or positive airway pressure) for OSA did not show significant changes in BP. Research on childhood OSA and renal outcomes is very limited. Conclusion: Our results demonstrate the association between childhood OSA and higher risk of adverse systemic BP outcomes. OSA treatment alone, however, has not been demonstrated to improve BP outcomes yet. Children with OSA and systemic hypertension should be assessed for further need of BP treatment to reduce long‐term cardiovascular morbidity and mortality.