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A Meta-analysis

Elias Zintzaras, MSc, PhD; Athanasios G. Kaditis, MD

Arch Pediatr Adolesc Med. 2007;161(2):172-178.

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 [I²] = 53%), whereas studies recording diastolic BP had moderate heterogeneity (I² = 31%). During sleep, large heterogeneity was identified among studies regarding elevated systolic BP (I² = 54%), and the random-effects OR was 1.20 (95% CI, 0.29-5.02). No heterogeneity was detected regarding elevated diastolic BP (I² = 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.

Author Affiliations: Departments of Biomathematics (Dr Zintzaras) and Pediatrics and the Sleep Disorders Laboratory (Dr Kaditis), University of Thessaly School of Medicine, Larissa, Greece.

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