Background/Objectives: Obstructive sleep apnea (OSA) is marked by repetitive occurrences of upper airway (UA) obstruction during sleep. Morbidities impacting the metabolic, cardiovascular (CV) and neurological systems are correlated with OSA. Only a few studies have described the existence of different characteristics depending on sex and, to date, the girl phenotype in OSA pediatrics is not well known. The objective of this systematic review is to identify the specific phenotype of OSA in pediatric and adolescent females compared to males. Methods: A systematic review was performed. The terms “pediatric sleep apnea” and “sex differences” were used to look for publications using PubMed, the Cochrane Library and Web of Science. Inclusion criteria: (1) peer-reviewed journal articles written in English; (2) investigations conducted on individuals diagnosed with OSA; and (3) investigations providing information about sex differences. Exclusion criteria: (1) studies carried out with individuals aged 18 years and older; (2) studies involving a sample size of fewer than 10 patients; and (3) editorials, letters and case reports. Results: Fifteen studies were included and classified in sections related to sex-based differences. Conclusions: Limited information related to sex-based OSA differences in the pediatric population exists. These differences are conditioned by hormonal status, and are minimal in the premenarcheal period. Moreover, adolescent women present a lower prevalence of obesity and craniofacial alterations, lower OSA severity related to higher UA area and earlier tonsil regression. Hyperactivity is more frequent in boys. Some studies pointed to a higher risk of high diastolic blood pressure in girls than in boys.

Current data support an increase in the prevalence of high blood pressure (HBP) in pediatric patients with sleep-disordered breathing (SDB). Adeno-tonsillectomy has been shown to be an effective treatment for most patients. Our objective was to determine the prevalence of HBP in pediatric patients with SDB and the impact of adeno-tonsillectomy with a multicenter, longitudinal, and prospective study that included 286 children referred for suspected SDB. The diagnosis of SDB was established by polysomnography (PSG) and the diagnosis of HBP by 24-h ambulatory blood pressure monitoring (ABPM). In patients without SDB and SDB without treatment indication, these tests were repeated six months after the baseline visit. For patients with medical treatment for SDB, the tests were repeated six months after the treatment initiation. Finally, in patients with surgery indication, ABPM was performed just before surgical treatment and ABPM and PSG six months after the intervention. The study contributes to elucidating the association between SDB and HBP in pediatric patients. Moreover, it contributes to determining if intervention with adeno-tonsillectomy is associated with BP reduction. The results have direct implications for the management of SDB, providing essential information on treatment indications for existing clinical guidelines. NCT03696654.

The limitations of pharmacological treatments for chronic pain have become increasingly evident: dependency, side effects, resistance, and diminishing efficacy. The urgent need for innovative solutions has become a compelling focus for improving patient outcomes. Innovative non-pharmacological approaches, such as sleep management, as a strategy to reduce opioid consumption and pain control are needed. The aim was to evaluate the impact of a Sleep and Circadian Intervention Program (SCIP) in the control of chronic musculoskeletal pain (CMP). This was a randomized clinical trial (NCT03646084), in which 49 CMP patients were assigned to SCIP (n = 15, mean age 51 years and 40% women) or non-SCIP groups (n = 26, 53 years and 61.5% women). Outcomes were evaluated after 6 months through self-reported questionnaires (pain intensity, physical function, depression/anxiety, and quality of life (QoL)). The SCIP group was assessed by polysomnography and specific questionnaires and was treated for diagnosed sleep disorders according to clinical guidelines. This population showed a moderate pain intensity at baseline, important deterioration of QoL and pathological anxiety/fear related to pain. Fifty percent of them presented restless leg syndrome, 60% moderate/severe insomnia, and 62.5% sleep apnea. During the follow-up, the SCIP group presented a greater reduction in the abnormal risk group for anxiety (from 73.3% to 46.7%) and depression (from 53.3% to 33.3%) on the Hospital Anxiety and Depression Scale compared to the non-SCIP group (from 40% to 29.2% and 33.3% to 29.2%, respectively). Also, a positive significant effect on anxiety/fear related to pain was found in the Pain Anxiety Symptoms Scale multivariable model, with an important improvement in symptoms. The application of SCIP in CMP patients improved anxiety and controlled associated sleep disorders, highlighting the impact on insomnia. Larger studies are needed for better understanding of the sleep intervention in CMP control.

Obstructive sleep apnea (OSA) in children is associated with cardiovascular risk, but its impact on sleep blood pressure (BP) remains incompletely understood. To assess the association between the severity of OSA, stratified by the obstructive apnea-hypopnea index (OAHI), and altered sleep BP patterns, specifically the non-dipping pattern (NDP), using ambulatory 24-h BP monitoring (ABPM). The Kids-Trial is a multicenter observational trial (NCT03696654) conducted in Spain, including children with suspected OSA that underwent polysomnography for its diagnosis. To estimate the impact of OAHI on the risk of NDP, a multivariable logistic regression model was constructed and odds ratio (OR) was calculated. A total of 267 children were included (median age of 6 years and 42.7 % girls). When BP was assessed through z-score, significant positive trends were observed according to OSA severity in 24-h mean BP, 24-h systolic BP, sleep mean BP, sleep systolic BP, sleep diastolic BP, and NDP. A negative trend was observed for the drop in sleep mean BP. The adjusted model showed that severe OSA was independently associated with a reduced drop in mean BP (-3.68 (-6.9; -0.47); p = 0.026). Adjusted multivariable analysis of NDP showed an increased but not significant risk of NDP in severe OSA vs. non-OSA (OR = 2.76 (0.92, 8.30)). Severe pediatric OSA was independently associated with disrupted nocturnal BP regulation, including a reduced BP dipping. These findings underscore the importance of ABPM in pediatric sleep evaluations. clinicaltrials.gov NCT03696654.