Higher BMI z-score was significantly associated with high blood pressure in children evaluated for sleep apnea, independent of AHI and asthma status (OR 1.93; 95% CI 1.37-2.78; p<0.001).
Observational (n=333)
Are sleep parameters and comorbidities different in children with high blood pressure compared to those with normal blood pressure?
In children evaluated for sleep apnea, higher BMI z-score and increased apnea-hypopnea index (particularly during REM sleep) are significantly associated with high blood pressure, emphasizing the need for OSA screening to mitigate cardiovascular risk.
Effect estimate: OR 1.93 (95% CI 1.37-2.78)
p-value: p=<0.001
Abstract Background Obstructive sleep apnea (OSA) is associated with essential hypertension in children with obesity. However, OSA treatment alone does not show improvement in blood pressure (BP). There is paucity of data comparing sleep parameters in children with obesity with and without high blood pressure. In this study, we hypothesized that children with and without high BP and obesity will have distinct comorbidities and sleep parameters. Methods In an ongoing observational study, we collected data on children with ICD code diagnosis of obesity who underwent polysomnogram (PSG) between August, 2021 and June, 2025. We stratified the cohort into high-BP (systolic blood pressure ≥130mmHg or diastolic blood pressure ≥80mmHg) and normal-BP. OSA status was classified by an apnea-hypopnea index (AHI) 5 (vs. none/mild 5). Obesity was defined as BMI z-score 2. End tidal CO2 (ETCO2) burden was expressed as percent of total sleep time 50 mmHg. Mean differences by BP group were compared using Chi-Square/Fisher’s Exact or Wilcoxon rank-sum tests. Logistic regression models were fit to examine the association of BMI z-score and BP group, adjusting for other covariates. Results Among 333 patients, 71 had high BP (21%). Obesity was more prevalent in the high-BP group compared to the normal-BP group (77% vs 47%, p 0.001), with no difference in the prevalence of asthma. Average BMI z-score was significantly greater in the high-BP group (2.4 vs. 1.9; p 0.001). OSA was more prevalent in the high-BP group compared to the normal-BP group (66% vs. 52%, p = 0.048); severity categories are shown in Figure 1. AHI and REM AHI were significantly higher in the high-BP group compared to the normal-BP group (median AHI 7.5 SD = 13.2 vs 5.3 SD = 14.8, p = 0.025; and median REM AHI 16.8 SD = 20.8 vs 11.2 SD = 23.2, p = 0.032). After adjusting for AHI and asthma status, BMI z-score remained significantly associated with high BP (OR = 1.93 95%CI=1.37-2.78, p 0.001). There were no differences in average sleep efficiency, saturations, or ETCO2 between BP groups. Conclusion Our preliminary results show that children with obesity and OSA are at higher risk for adverse cardiovascular outcomes, such as elevated BP. In children with high BP, there was a significant increase in AHI, particularly during REM sleep, when there is a known sympathetic surge. This highlights the clinical importance of screening OSA in obese children to mitigate cardiovascular risk. Figure 1. OSA severity categories by blood pressure (BP) group. OSA categories defined as OSA none/mild (AHI5), moderate (AHI 5-10), or severe (AHI ≥10). This abstract is funded by: None
Jalou et al. (2026) conducted an observational in Obesity and Obstructive Sleep Apnea (n=333). High blood pressure vs. Normal blood pressure was evaluated on High blood pressure (association with BMI z-score) (OR 1.93, 95% CI 1.37-2.78, p=<0.001). Higher BMI z-score was significantly associated with high blood pressure in children evaluated for sleep apnea, independent of AHI and asthma status (OR 1.93; 95% CI 1.37-2.78; p<0.001).