• Chung-Guei Huang, Jen-Fu Hsu, Li-Pang Chuang, Hsueh-Yu Li, Tuan-Jen Fang, Yu-Shu Huang, Albert C Yang, Guo-She Lee, KuoTerry B JTBJInstitute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.Center for Mind and Brain Medicine, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan, ROC.Sleep Research Center, National Ya, YangCheryl C HCCHInstitute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.Sleep Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC., Li-Ang Lee, and Hai-Hua Chuang.
• Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
• J Chin Med Assoc. 2023 Jun 1; 86 (6): 596605596-605.

BackgroundAdenotonsillar hypertrophy is the most common cause of pediatric obstructive sleep apnea (OSA). Although adenotonsillectomy considerably reduces OSA and systemic inflammation, whether and how systemic inflammation influences the effects of adenotonsillectomy on OSA has yet to be determined.MethodsThis study investigated the associations between changes in anatomical variables, % changes in subjective OSA-18 questionnaire scores, % changes in 11 polysomnographic parameters, and % changes in 27 systemic inflammatory biomarkers in 74 children with OSA.ResultsFifty-six (75.6%) boys and 18 (24.4%) girls with the mean age of 7.4 ± 2.2 years and apnea-hypopnea index (AHI) of 14.2 ± 15.9 events/h were included in the statistical analysis. The mean period between before and after adenotonsillectomy was 5.6 ± 2.6 months. After adenotonsillectomy, the OSA-18 score, eight of 11 polysomnographic parameters, and 20 of 27 inflammatory biomarkers significantly improved (all p < 0.005). Notably, there were significant associations between change in tonsil size and % change in AHI ( r = 0.23), change in tonsil size and % changes in interleukin-8 (IL-8) ( r = 0.34), change in tonsil size and % change in and IL-10 ( r = -0.36), % change in IL-8 and % change in C-C chemokine ligand 5 (CCL5) ( r = 0.30), and % change in CCL5 and % change in AHI ( r = 0.38) (all p < 0.005). Interestingly, % change in IL-8 and % change in CCL5 serially mediated the relationship between change in tonsil size and % change in AHI (total effect: β = 16.672, standard error = 8.274, p = 0.048).ConclusionThese preliminary findings suggest that systemic inflammation is not only a complication of OSA but also that it mediates the surgical effects, which may open avenues for potential interventions to reduce tonsil size and OSA severity through the regulation of IL-8 and CCL5.Copyright © 2023, the Chinese Medical Association.

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