Abstract
Background: Inflammation is often considered relating to pediatric obstructive sleep apnea (OSA). We conducted a study investigating cytokines, including Il-17 and Il-23, in children with OSA before and after adenotonsillectomy (T&A), compared with controls. Methods: Children with OSA between age 4 and 12 receiving T&A were prospectively followed. Evaluation before and reevaluation six months after the treatment were done, including polysomnography (PSG), blood tests, and questionnaires. Blood samples were obtained to determine the values of high-sensitivity-C-reactive-protein (HS-CRP); tumor-necrosis-factor-alpha (TNF-α); and interleukin (IL)-1, 6, 10, 12, 17, and 23. We compared the results with an age-matched control group. Results: We included 55 OSA children and 32 controls. Children with OSA presented significant improvement after T&A in complaints, signs, apnea hypopnea index (AHI) (p < 0.001), mean oxygen desaturation index (p < 0.001), and mean oxygen saturation (p = 0.010). Upon entering this study, children with OSA had significantly higher cytokine levels than the controls and significant changes in HS-CRP (p = 0.013), TNF-α (p = 0.057), IL-1β (p = 0.022), IL-10 (p = 0.035), and IL-17 (p = 0.010) after T&A. Children with improved but persistently abnormal AHI did not have all cytokine levels normalized, particularly IL-23 and HS-CRP. Conclusion: Sleep-disordered breathing can persist after T&A and can continue to have a negative inflammatory effect. HS-CRP and IL-23 may serve as blood markers for the persistence of sleep-disordered breathing after T&A.
Highlights
Adult obstructive sleep apnea (OSA) syndrome has been associated with a number of comorbidities, in obese patients [1,2,3,4,5,6,7,8,9]
We reported that HS-C-reactive protein (CRP), IL-17, and IL-23 were elevated in children with OSA compared with healthy controls [11] and that most of them had tonsil or adenoid hypertrophy
(3) In the apnea hypopnea index (AHI) ≤ 1 subgroup, we found that the plasma levels of HS-CRP, IL-1β, IL-10, and IL-17 did not differ significantly from healthy controls, but IL-23 was still significantly higher
Summary
Adult obstructive sleep apnea (OSA) syndrome has been associated with a number of comorbidities, in obese patients [1,2,3,4,5,6,7,8,9]. A decreased upper-airway (UA) size is considered a risk-factor for UA collapse during sleep. One of the most common factors is enlarged adenoids and tonsils, which impact nasal air exchange, lead to mouth-breathing, and increase the risk of UA collapse during sleep [13]. Previous studies have shown that plasma pro-inflammatory cytokines, such as high density-CRP (HS-CRP), TNF-α, IL-1β, IL-6, and IL-10, were elevated in children with OSA. We reported that HS-CRP, IL-17, and IL-23 were elevated in children with OSA compared with healthy controls [11] and that most of them had tonsil or adenoid hypertrophy. We followed cytokine level changes in patients with both pediatric OSA and enlarged adenoids or tonsils, before and after T&A, and analyzed possible association between cytokine levels and sleep variables
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