0884 INFLAMMATORY FACTORS PRE AND POST ADENOTONSILLECTOMY IN PEDIATRIC OBSTRUCTIVE-SLEEP-APNEA

Abstract

Introduction: Systemic inflammation is commonly advanced as related to pediatric obstructive-sleep-apnea. Increase in high-sensitive CRP has been shown in association with the syndrome, with decrease following adenotonsillectomy. Many inflammatory factors have been identified with complex interaction between factors. We performed a study of interleukines 17 and 23 that control other interleukines on children before and after adenotonsillectomy. Methods: Children between 6 to 16 years diagnosed with obstructive- sleep-apnea based on clinical evaluation, anatomic evaluation of upper-airway including classification of tonsils and nocturnal polysomnography that were submitted to adenotonsillectomy and prospectively followed with new evaluation 6 months post treatment. Blood samples were obtained at each evaluation and determination of plasma high-sensitivity-CRP, tumor necrosis factor alpha, interleukins 1,6,10,17,and 23. Results: 31 children, mean age 7.5 ± 0.6 years,36% girls, had changed from pre to post surgery with a mean apnea-hypopnea-index of 15.95 versus 2.9 (p=0.006), a mean oxygen-desaturation-index of 13.7 versus 2.7 (p=0.005). Mean heart rate during sleep changed from 87 to 79 beats/minute (p=0.002).Inflammatory factors also decreased after surgery indicating improvement such as high-sensitivity-CRP (p=0.01),Tumor-necrotic-alpha(p=0.046), interleukines 1 (p=0.019), 17 (p=0.039).But interleukine 6 had no change (p=0.11), as did interleukin 10 (p=0.112) and interleukine 23 (p=0.224). Interleukin 6 was not significantly increased at entry compared to expected normal level and did not change. Conclusion: Adenotonsillectomy did not bring the total group to complete normal AHI despite clear overall improvement. If the pro-inflammatory interleukine 17, secreted predominantly by the T helper 17 cells,is significantly improved,the abnormal up-regulation of 17 appears to have decreased with surgery. The interleukine 23 was not significantly change despite the clinical improvement. Interleukine 23 is a cytokine with immunomodulatory effect. One of its reported activity is to differentiate naïve T cells into IL-17-producing TH17 cells. Adenotonsillectomy may not eliminate mouth-breathing, and persistence of mild sleep-disordered-breathing may still have a negative effect on inflammatory factors.