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Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study.

Kheirandish-Gozal L, Gileles-Hillel A, Alonso-Álvarez ML, Peris E, Bhattacharjee R, Terán-Santos J, Duran-Cantolla J, Gozal D - Int J Obes (Lond) (2015)

Bottom Line: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A.Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).

View Article: PubMed Central - PubMed

Affiliation: Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.

ABSTRACT

Background: Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions.

Aim: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.

Methods: Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin.

Results: Out of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).

Conclusions: A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

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Related in: MedlinePlus

Receiver operator curves using individual plasma metabolic or inflammatory markers defined cut-off values for prediction of residual OSA after T&A in obese children.
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Figure 1: Receiver operator curves using individual plasma metabolic or inflammatory markers defined cut-off values for prediction of residual OSA after T&A in obese children.

Mentions: Based on these findings we examined receiver operator curves for prediction of T&A outcomes (resolved vs. persistent residual OSA using AHI≥5hrTST) initially using single biomarkers, and then clusters of biomarker subsets (Figure 1). Of all the biomarkers, the best performers included MCP-1, MMP-9, PAI-1, and adiponectin. MMP-9 and MCP-1 were essentially interchangeable, such that including them in combinatorial analyses did not yield any improvements in the AUC. Accordingly, MCP-1 and PAI-1 achieved an AUC of 0.809 with a sensitivity of 0.7 and a specificity of 0.9 (p<0.0001; Figure 1). Addition of adiponectin to these 2 markers resulted in improved AUC (0.858; p<0.0001) with higher sensitivity (0.9) but lower specificity (0.63).


Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study.

Kheirandish-Gozal L, Gileles-Hillel A, Alonso-Álvarez ML, Peris E, Bhattacharjee R, Terán-Santos J, Duran-Cantolla J, Gozal D - Int J Obes (Lond) (2015)

Receiver operator curves using individual plasma metabolic or inflammatory markers defined cut-off values for prediction of residual OSA after T&A in obese children.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496251&req=5

Figure 1: Receiver operator curves using individual plasma metabolic or inflammatory markers defined cut-off values for prediction of residual OSA after T&A in obese children.
Mentions: Based on these findings we examined receiver operator curves for prediction of T&A outcomes (resolved vs. persistent residual OSA using AHI≥5hrTST) initially using single biomarkers, and then clusters of biomarker subsets (Figure 1). Of all the biomarkers, the best performers included MCP-1, MMP-9, PAI-1, and adiponectin. MMP-9 and MCP-1 were essentially interchangeable, such that including them in combinatorial analyses did not yield any improvements in the AUC. Accordingly, MCP-1 and PAI-1 achieved an AUC of 0.809 with a sensitivity of 0.7 and a specificity of 0.9 (p<0.0001; Figure 1). Addition of adiponectin to these 2 markers resulted in improved AUC (0.858; p<0.0001) with higher sensitivity (0.9) but lower specificity (0.63).

Bottom Line: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A.Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).

View Article: PubMed Central - PubMed

Affiliation: Section of Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.

ABSTRACT

Background: Obesity and obstructive sleep apnea syndrome (OSA) are highly prevalent and frequently overlapping conditions in children that lead to systemic inflammation, the latter being implicated in the various end-organ morbidities associated with these conditions.

Aim: To examine the effects of adenotonsillectomy (T&A) on plasma levels of inflammatory markers in obese children with polysomnographically diagnosed OSA who were prospectively recruited from the community.

Methods: Obese children prospectively diagnosed with OSA, underwent T&A and a second overnight polysomnogram (PSG) after surgery. Plasma fasting morning samples obtained after each of the two PSGs were assayed for multiple inflammatory and metabolic markers including interleukin (IL)-6, IL-18, plasminogen activator inhibitor-1 (PAI-1), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9), adiponectin, apelin C, leptin and osteocrin.

Results: Out of 122 potential candidates, 100 obese children with OSA completed the study with only one-third exhibiting normalization of their PSG after T&A (that is, apnea-hypopnea index (AHI) ≤1/hour total sleep time). However, overall significant decreases in MCP-1, PAI-1, MMP-9, IL-18 and IL-6, and increases in adropin and osteocrin plasma concentrations occurred after T&A. Several of the T&A-responsive biomarkers exhibited excellent sensitivity and moderate specificity to predict residual OSA (that is, AHI⩾5/hTST).

Conclusions: A defined subset of systemic inflammatory and metabolic biomarkers is reversibly altered in the context of OSA among community-based obese children, further reinforcing the concept on the interactive pro-inflammatory effects of sleep disorders such as OSA and obesity contributing to downstream end-organ morbidities.

Show MeSH
Related in: MedlinePlus