Abstract
Both obstructive sleep apnea (OSA) and obesity are major health issues that contribute to increased systemic inflammation in children. To date, adenotonsillectomy (AT) is still the first-line treatment for childhood OSA. However, the relationships among and predictive values of obesity, inflammation, and OSA severity have not been comprehensively investigated. This prospective study investigated body mass index (BMI), serum inflammatory markers, and OSA severity before and after AT in 60 pediatric patients with OSA. At baseline, differences in levels of interleukin-6, interleukin-9, basic fibroblast growth factor, platelet-derived growth factor-BB, as well as regulated on activation, normal T cell expressed and secreted (RANTES) were significant among the various weight status and OSA severity subgroups. After 3 months postoperatively, the differences in these inflammatory markers diminished along with a decrease in OSA severity while obesity persisted. The rate of surgical cure (defined as postoperative obstructive apnea-hypopnea index < 2.0 and obstructive apnea index < 1.0) was 62%. Multivariate analysis revealed that age, BMI z-score, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1, and RANTES independently predicted surgical cure. Despite the significant reductions in inflammatory markers and OSA severity after AT, an inter-dependent relationship between obesity and OSA persisted. In addition to age and BMI, several inflammatory markers helped to precisely predict surgical cure.
Highlights
Obstructive sleep apnea (OSA), a common chronic disorder with an increasing prevalence in many developed countries [1,2,3,4], is characterized by recurrent episodes of partial and complete airway obstructions during sleep with repetitive apneas and hypopneas [2]
There were significant differences in body mass index (BMI) z-scores, obstructive apnea-hypopnea index (OAHI), obstructive apnea index (OAI), mean oxygen saturation measured by pulse oximetry (SpO2), and minimal SpO2; there were no significant differences in age, sex, and obstructive sleep apnea (OSA)-18
Levels of IL-9 were higher in non-obese patients than obese patients with the same OSA severity
Summary
Obstructive sleep apnea (OSA), a common chronic disorder with an increasing prevalence in many developed countries [1,2,3,4], is characterized by recurrent episodes of partial and complete airway obstructions during sleep with repetitive apneas and hypopneas [2]. Previous studies have shown that obesity is one of the most important risk factors for OSA, along with increasing age, male sex, and craniofacial structure abnormalities [2,3]. Among those affected, pediatric patients are of particular concerns. The prevalence of the disease is reported to be 2%–3% Enlarged lymphoid tissues such as the tonsils and adenoids are considered the most important factors for pediatric OSA [5]. Considering the lack of solid links between weight status, lymphoid tissue size, and OSA severity in pediatric patients, other pathophysiological mechanisms have been postulated [9,10], either alone or in combination with obesity
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