Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

Abstract

Objective To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). Study Design Systematic review and meta‐analysis. Methods The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and inflammatory cytokines were evaluated using a random‐effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. Results Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by −11.3 events/h (95% confidence interval [CI], −15.8 to −6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) levels, respectively. Sleep surgery significantly reduced TNF‐α levels, with an MD of −2.8 pg/ml (95% CI, −5.1 to −0.6) and an SMD of −0.56 (95% CI, −0.85 to −0.27). Furthermore, sleep surgery reduced IL‐6 levels, with an MD of −0.6 pg/ml (95% CI, −1.0 to −0.2) and an SMD of −0.66 (95% CI, −0.89 to −0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta‐regression analyses. Funnel plots showed possible publication bias in current data. Conclusions In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275–2284, 2022

Adenotonsillectomy-related changes in systemic inflammation among children with obstructive sleep apnea

“…Furthermore, montelukast has been shown to markedly reduce tonsil size and adenoid size 54 and suppress the release of IL-8 and CCL5 by nasal airway epithelial cells, 55 and also to have short-term beneficial treatment effects for pediatric OSA. 56 On the other hand, serum from continuous positive airway pressuretreated 57 or sleep surgery-treated 58 adults with OSA had lower inflammatory gene expressions than serum from OSA patients without treatment. Therefore, both continuous positive airway pressure and sleep surgery not only increases the upper airway size to improve intermittent hypoxia and systemic inflammation but also reduces the overall inflammatory potential in the circulation to alleviate upper airway collapse.…”