A new surgical technique versus an old marker: can expansion sphincter pharyngoplasty reduce C-reactive protein levels in patients with obstructive sleep apnea?

Abstract

The aim of this study was to evaluate the change in serum levels of C-reactive protein (CRP) in patients with obstructive sleep apnea (OSA) before and after expansion sphincter pharyngoplasty (ESP) and continuous positive airway pressure (CPAP) treatment. Fifty-one patients with newly diagnosed OSA were prospectively enrolled in this study. We performed ESP in twenty-three patients in the surgery group and twenty-eight patients were included in the CPAP group. Serum levels of high-sensitivity CRP (hs-CRP) were analyzed by enzyme-linked immunosorbent assays before and 3 months after treatment. The relations between CRP and the apnea hypopnea index (AHI), visual analog scale (VAS), the Epworth Sleepiness Scale (ESS), and saturation parameters were evaluated. Both surgical and CPAP treatments caused significant improvements in the clinical and laboratory parameters. However, only the patients whose postoperative AHI levels improved to final AHI of <5 (n = 6) after ESP, had significant decrease in their serum CRP levels (p = 0.028). CPAP group and the rest of the patients in the surgery group did not show statistically significant difference in CRP levels after treatment. We suggest that the successful surgical treatment for OSA-ESP in this study-, which provides OSA cure, can decrease serum levels of CRP and reduce possible cardiovascular morbidity.

Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

“…Seven studies measured serum high‐sensitivity CRP, 25–28, 30,31,33 and two studies measured serum CRP 29,32 . The SMD (95% CI) for high‐sensitivity CRP levels was −0.28 (−0.46 to −0.10), which was not significantly different from that for serum CRP levels (SMD = −0.71; 95% CI, −1.66 to 0.24) ( P for interaction = .38).…”

“…Among the studies, 31 were published as full‐text articles and were thus assessed in this meta‐analysis. Eleven studies described adults with OSA who received surgery and provided CRP measurements 23–33 . However, two studies by Marvisi et al and Vicente et al did not provide raw data required for meta‐analysis 23,24 ; their corresponding authors were contacted, but the data were still unavailable.…”

“…Table I lists the baseline characteristics of the nine included studies (277 patients) 25–33 . All nine studies were retrospective or prospective case series; only one study included a normal control group 30 .…”

“…Of the included studies, one was conducted in Japan, 25 one in China, 29 two in Taiwan, 28,30 two in Turkey, 31,32 and three in the United States 26,27,33 . The mean patient age was 46.5 ± 6.1 years, and 92% of the patients were men.…”

“…The mean BMI was 28.6 ± 1.4 kg/m 2 . Soft tissue surgery was performed in eight studies (e.g., nasal, pharyngeal, or tongue base surgery) 25–32 ; skeletal surgery (i.e., maxillomandibular advancement) was performed in only one study 33 . No study reported the use of tracheostomy or nerve stimulation for OSA.…”