Objectives: Obstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA.
Methods: Children under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO2 monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again.
Results: Thirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE4 levels decreased from 961.9 (684.8-1438.2) to 708.6 (538.2-1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children.
Conclusions: Adenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.
Keywords: Adenotonsillar hypertrophy; Adenotonsillectomy; Cysteinyl leukotrienes; Leukotriene E4; Obstructive sleep apnea; Sleep disordered breathing.
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