The autonomic or involuntary nervous system consists of two components, the sympathetic and the parasympathetic. The sympathetic governs what is referred to as the “fright or flight” response. It prepares us to deal with extreme stress by releasing epinephrine. The parasympathetic, via acetylcholine promotes relaxation. Sleep usually reduces cellular needs for oxygen and glucose. Sympathetic tone increases during obstructive sleep apnea in children and persists beyond sleep and suppresses vagal tone. The vagus nerve controls resting heart rate. It keeps a happy balance between stress coping and relaxation.
The autonomic regulatory changes affected by pediatric sleep apnea cause changes in the cardiovascular system. Obstructive sleep apnea in kids is consistently associated with hypertension or high blood pressure. Kids with obstructive sleep apnea are over 3 times more likely to have hypertension than kids not having it. Studies of kids with obstructive sleep apnea show them to have high blood pressure both day and nighttime, and the elevation is proportionate to the severity of the apnea. Furthermore, elevated blood pressure in children predicts cardiovascular risks later in life.
C-reactive protein was also shown to increase in children with obstructive sleep apnea. C-reactive protein is a sensitive marker for systemic inflammation. Inflammation contributes to endothelial dysfunction, resulting in vasoconstriction and eventually atherosclerosis (hardening of the arteries).
FAILURE TO TREAT PEDIATRIC SLEEP DISORDERED BREATHING APPEARS TO LEAVE CHILDREN AT RISK FOR LONG-TERM CARDIOVASCULAR CONSEQUENCES