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

International Journal of Obesity volume 39, pages 1094–1100 (2015)Cite this article

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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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Acknowledgements

We thank the subjects and their parents for their participation, and the Basque Biobank For Research-OEHUN for their collaboration. LKG and DG are supported by a grant HL-65270 from the National Institutes of Health. RB is supported by American Heart Association grant 13SDG14780079. MLA, JTS and JDC were supported by the Spanish Respiratory Society (SEPAR) and Mutua Madrileña.

ClinicalTrials.gov Identifier: NCT01322763 (url: http://clinicaltrials.gov/ct2/show/NCT01322763?term=NCT01322763&rank=1)

Author Contributions

LKG, MLA, JTS and JDC participated in the conceptual framework of the project, performed experiments, analyzed data and drafted components of the manuscript. EP and AGH performed experiments and assisted with analyses. RB contributed to subject recruitment and critical discussions. LKG, MLA and DG conceptualized the project, provided critical input in all phases of the experiments, analyzed data, drafted the ulterior versions of the manuscript and are responsible for the financial support of the project and the manuscript content. All authors have reviewed and approved the final version of the manuscript.

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Authors and Affiliations

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

    L Kheirandish-Gozal, A Gileles-Hillel, E Peris, R Bhattacharjee & D Gozal

  2. Sleep Unit, Burgos, Spain

    M L Alonso-Álvarez, J Terán-Santos & J Duran-Cantolla

  3. CIBER of Respiratory Diseases. Instituto Carlos III.CIBERES, Burgos, Spain

    M L Alonso-Álvarez, J Terán-Santos & J Duran-Cantolla

  4. Hospital Universitario de Burgos (HUBU), Burgos, Spain

    M L Alonso-Álvarez & J Terán-Santos

  5. Hospital Universitario de Araba, Vitoria, Spain

    J Duran-Cantolla

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  1. L Kheirandish-Gozal
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Correspondence to L Kheirandish-Gozal or D Gozal.

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Kheirandish-Gozal, L., Gileles-Hillel, A., Alonso-Álvarez, M. et al. Effects of adenotonsillectomy on plasma inflammatory biomarkers in obese children with obstructive sleep apnea: A community-based study. Int J Obes 39, 1094–1100 (2015). https://doi.org/10.1038/ijo.2015.37

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