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Serum Biomarkers after Adenotonsillectomy for Pediatric OSA: A Systematic Review and Meta-Analysis
Yichen Ding1, Jin Hean Koh1, Xing Yi Cheah1
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Insights
Adenotonsillectomy significantly improves key inflammatory and cardiometabolic markers in children diagnosed with obstructive sleep apnea (OSA). The procedure led to lower C-reactive protein (CRP), insulin, and Brain Natriuretic Peptide (BNP) levels, alongside increased Insulin-like Growth Factor 1 (IGF-1).
Area of Science:
- Pediatric Sleep Medicine
- Cardiometabolic Health
- Inflammatory Biomarkers
Background:
- Obstructive sleep apnea (OSA) in children is linked to adverse inflammatory and cardiometabolic profiles.
- Adenotonsillectomy is a primary treatment for pediatric OSA, but its systemic effects on biomarkers require comprehensive assessment.
Purpose of the Study:
- To evaluate the impact of adenotonsillectomy on serum inflammatory and cardiometabolic markers in pediatric patients with diagnosed OSA.
- To synthesize evidence from existing studies using meta-analysis to determine the efficacy of adenotonsillectomy on specific biomarkers.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Cochrane databases up to August 2022.
- Meta-analyses of standardized mean differences (SMD) were performed on data from 26 included studies (1331 participants).
- Key outcomes included changes in C-reactive protein (CRP), insulin, Brain Natriuretic Peptide (BNP), and Insulin-like Growth Factor 1 (IGF-1).
Main Results:
- Adenotonsillectomy was associated with significant reductions in insulin (SMD = -0.322), CRP (SMD = -0.946), and BNP (SMD = -1.416).
- A significant increase in Insulin-like Growth Factor 1 (IGF-1) levels was observed (SMD = 0.691).
- No significant changes were noted for triglyceride, total cholesterol, TNF-α, LDL, HDL, glucose, IL-10, or IL-6 levels.
Conclusions:
- Adenotonsillectomy demonstrates a beneficial effect on specific serum biomarkers in children with OSA.
- The procedure is associated with improved inflammatory status (lower CRP) and cardiometabolic risk factors (lower insulin, BNP; higher IGF-1).
- These findings support adenotonsillectomy as an effective intervention for mitigating systemic effects of pediatric OSA.
Objective:
To assess whether adenotonsillectomy improves levels of inflammatory and cardiometabolic markers in children with polysomnographically diagnosed obstructive sleep apnea (OSA).
Data Sources:
Two authors independently searched PubMed, Embase, and Cochrane databases up to August 16, 2022, for studies relating to pre- and post-operative levels of serum markers in pediatric patients undergoing adenotonsillectomy.
Review Methods:
Data were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. We calculated the probability of benefit (POB) and number needed to treat (NNT) for outcomes that demonstrated a statistically significant effect after adenotonsillectomy. The primary outcomes were changes in serum markers including C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), Insulin-like growth factor 1 (IGF-1), interleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), Brain natriuretic peptide (BNP), insulin, glucose, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL).
Results:
We screened 1616 studies and included 26 studies with 1331 participants. Meta-analysis was performed on 20 of the included studies. Adenotonsillectomy was associated with a significant decrease in insulin levels (SMD = -0.322, 95% Confidence Interval (CI) = -0.583 to -0.061), CRP (SMD = -0.946, 95% CI = -1.578 to -0.314), and BNP (SMD = -1.416, 95% CI = -2.355 to -0.477) and significant increase in levels of IGF-1 (SMD = 0.691, 95% CI = 0.207 to 1.176). There were no significant changes in levels of triglyceride, total cholesterol, TNF-α, LDL, HDL, glucose, IL-10, and IL-6.
Conclusion:
In children with polysomnographically diagnosed OSA, adenotonsillectomy was associated with improvements in serum biomarkers, comprising lower CRP, insulin, and BNP, and higher IGF-1. Laryngoscope, 134:3030-3037, 2024.
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