0920 Impact of Elevated Periodic Limb Movement Index and OSA on Blood Pressure in Children

Abstract Introduction The combination of obstructive sleep apnea (OSA) and elevated periodic limb movement index (PLMI) may have an increased impact on blood pressure (BP). Our aim of this study was to assess the impact of both OSA and elevated PLMI on BP in children with OSA and elevated PLMI. Methods This study was a single-center retrospective analysis of children under 18 years old who had an OSA and PLMI > 5 and had their BP recorded before and after sleep studies. OSA severity was categorized by obstructive apnea-hypopnea index (OAHI) as normal (< 1.5 events/hr), mild (1.5–4.9 events/h), moderate (5–9.9 events/h), and severe (≥ 10 events/h). BP was categorized as normal, elevated, or stage 1 or 2 hypertension according to AAP 2017 guidelines. Results 176 children with a PLMI of greater than 5 events per hour with recorded pre/post PSG blood pressures during sleep studies data were analyzed. Primary snoring, mild, moderate, and severe OSA were 43.8%, 26.7%, 11.9%, and 17.6%, respectively. The median age in each group was 9, 10, 9, and 13, respectively. The BMI z-score for each group was 0.9, 1.8, 2.3, and 2.4, respectively (p = 0.0002). BP categories were normal (64.5%, 34.0%, 38.1%, and 25.8%), elevated (11.8%, 25.5%, 14.3%, and 25.8%), stage 1 HTN (19.7%, 34.0%, 42.9%, and 29.0%), and stage 2 HTN (4.0%, 6.4%, 4.8%, and 19.4%) in each group. Between all groups, there was no significant difference seen in the PLMI and PLM arousal index. OSA severity was strongly and independently correlated with higher BP, particularly systolic BP (SBP) (p < 0.0001). A higher PLMI was also notably linked to increased morning systolic BP. Specifically, for each one-point rise in the PLMI the SBP increased by 0.27 mmHg (p = 0.010). However, when adjusting for age and BMI z-score, this association was no longer statistically significant (p = 0.066). Conclusion OSA severity is the main factor linked to higher blood pressure in children with OSA and elevated PLMI, while PLM indices were less influential on BP after accounting for age and BMI. Support (if any)