Alterations in Inflammatory Markers and Cognitive Ability after Treatment of Pediatric Obstructive Sleep Apnea
Mohamed Shams Eldin1, Mohamed Alahmer1, Ebrahim Alkashlan2
1Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo 11675, Egypt.
Insights
Obstructive sleep apnea (OSA) in children is linked to cognitive dysfunction and inflammation. Treatment, including adenotonsillectomy or lifestyle changes, significantly improves cognitive function and reduces inflammatory markers.
Area of Science:
- Pediatric Sleep Medicine
- Neuroinflammation
- Cognitive Neuroscience
Background:
- Obstructive sleep apnea (OSA) is increasingly recognized as a condition impacting children's health.
- The relationship between OSA, cognitive function (CF), and systemic inflammation (cytokines like TNF-α, IL-6) requires further elucidation in pediatric populations.
- Understanding the effects of OSA management on these parameters is crucial for effective intervention.
Purpose of the Study:
- To determine the impact of OSA on pediatric cognitive function and serum cytokine levels.
- To evaluate the effectiveness of OSA management strategies (adenotonsillectomy and lifestyle intervention) on these variables.
Main Methods:
- A cohort of 224 children underwent assessment using the Pediatric Sleep Questionnaire, NEPSY for CF, and polysomnography (PSG) to determine the apnea/hypopnea index (AHI).
- Treatment included adenotonsillectomy (AT) for severe cases or lifestyle intervention (LSI) for mild/moderate OSA in overweight/obese children.
- Serum cytokine levels were measured via ELISA, with re-evaluation after a 6-month follow-up.
Main Results:
- Following treatment, the Pediatric Sleep Questionnaire scores significantly decreased, and NEPSY scores improved in most patients.
- Cytokine levels (TNF-α, IL-6) were reduced post-intervention.
- Baseline NEPSY scores, AHI, and sleep questionnaire scores showed negative correlations, while changes in NEPSY and cytokine levels correlated positively.
Conclusions:
- Pediatric OSA is associated with significant cognitive dysfunction and elevated inflammatory markers.
- Adenotonsillectomy leads to substantial improvements in cognitive function.
- Lifestyle intervention is a viable option for mild OSA, potentially improving surgical outcomes when used preoperatively.
Abstract:
Background and Objectives: Determination of the impact of obstructive sleep apnea (OSA) on the cognitive function (CF), and serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and 1β levels and the effect of OSA management on these variables in children. Materials and Methods: A total of 224 patients were evaluated using the Pediatric Sleep Questionnaire, the NEPSY score for CF, and polysomnography (PSG) to grade OSA severity according to the apnea/hypopnea index (AHI). Adentonsillectomy (AT) was performed for patients with adenotonsillar hypertrophy grade > 2. Patients with overweight or obesity with mild or moderate OSAS underwent a 6-month protocol of lifestyle intervention (LSI). Blood samples were obtained for an enzyme-linked immunosorbent assay (ELISA) estimation of cytokine levels. All variables were re-evaluated at the end of the 6-month follow-up period. Results: A total of 181 patients had surgical interference and 43 patients underwent a LSI trial; 15 patients failed to respond and underwent surgery. At the end of the follow-up, 33 patients had residual OSAS with a significantly higher incidence among patients with severe OSAS, the mean score of the pediatric sleep questionnaire was significantly decreased in all patients, 181 patients showed an improved NESPY score, and cytokine levels were decreased. The baseline NESPY score, AHI index and sleep questionnaire score were negatively correlated. The percentage of change in the NESPY score and serum cytokine levels showed a positive correlation. Conclusions: OSAS is associated with cognitive dysfunction that significantly improves after adenotonsillectomy. LSI as a therapeutic line is satisfactory for children with mild OSAS and minimal cognitive dysfunction and is of value preoperatively to improve the surgical outcomes of AT.
