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CD4(+)T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome
1Sleep Disorders Centre and Department of Otolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Insights
Pediatric obstructive sleep apnea syndrome (OSAS) is linked to an imbalance in T-helper 17 (Th17) and regulatory T (Treg) cells, favoring Th17. This immune shift correlates with disease severity and inflammation, improving after surgery.
Area of Science:
- Immunology
- Pediatric Sleep Medicine
- Respiratory Medicine
Background:
- Obstructive sleep apnea syndrome (OSAS) in children is a growing concern.
- Understanding the immune system's role in pediatric OSAS is crucial for effective management.
- T-lymphocyte subsets play a significant role in immune regulation and inflammation.
Purpose of the Study:
- To characterize tonsillar and circulating CD4(+) T-lymphocyte subsets in children with OSAS.
- To explore the clinical relevance of these T-lymphocyte subsets in pediatric OSAS.
- To investigate the relationship between T-lymphocyte distribution and disease severity.
Main Methods:
- Prospective enrollment of 53 children undergoing tonsillectomy (OSAS or primary snoring) and 19 healthy controls.
- Quantification of CD4(+) T-lymphocyte subpopulations via flow cytometry.
- Measurement of serum cytokines and transcription factors using ELISA and qPCR.
Main Results:
- Comparable tonsillar T-lymphocyte subset distribution between OSAS and primary snoring groups.
- Positive correlation between peripheral Th17/Treg ratio, apnea-hypopnea index (AHI), C-reactive protein, and HIF-1α mRNA in OSAS children.
- AHI independently associated with peripheral Th17/Treg ratio; surgery reversed Th17/Treg imbalance and reduced inflammation.
Conclusions:
- Pediatric OSAS is associated with a Th17-predominant Th17:Treg imbalance.
- Altered lymphocytic phenotypes correlate with intermittent hypoxia in sleep apnea.
- These immune changes may contribute to systemic inflammation and comorbidities in pediatric OSAS.
Background:
To characterize the distribution of both tonsillar and circulating CD4(+)T-lymphocyte subsets, and to explore their clinical relevance in nonobese children with obstructive sleep apnea syndrome (OSAS).
Methods:
A total of 53 children who underwent tonsillectomy for either OSAS (n = 25) or primary snoring (PS, n = 28) were prospectively enrolled. Nineteen healthy children without any symptoms were recruited as controls. We quantified the frequencies of CD4(+)T-lymphocyte subpopulations using flow cytometry, serum-related cytokines using enzyme-linked immunosorbent assay, and key transcription factors using quantitative polymerase chain reaction (qPCR).
Results:
Tonsillar distributions of CD4(+)T-lymphocyte subsets were comparable in the OSAS and PS subjects. The peripheral Th17/Treg ratio was positively correlated to severity as measured by apnea/hypopnea index (AHI), serum C-reactive protein and hypoxia-inducible factor-1α mRNA in the OSAS children (P < 0.05). And AHI was independently associated with the peripheral Th17/Treg ratio (P < 0.05). Furthermore, the response to surgery was associated with a significant reversal of the Th17/Treg imbalance and a concomitant relief of the proinflammatory profile in the OSAS subjects.
Conclusion:
Pediatric OSAS was associated with an altered Th17:Treg balance toward Th17 predominance. The changes in lymphocytic phenotypes that correlated with recurrent intermittent hypoxia in sleep apnea may contribute to the variance in systemic inflammation and downstream morbidities of pediatric OSAS.
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