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

The Metabolic Outcomes of Obstructive Sleep Apnea Surgery: A Scoping Review

OBJECTIVES

To evaluate the available evidence on the metabolic outcomes of obstructive sleep apnea (OSA) surgery and identify gaps in the current literature.

DATA SOURCES

A literature search was performed using PubMed, Embase, Web of Science, and Cochrane Library databases.

REVIEW METHODS

Search strategy was developed with a senior informationist at our institution. Metabolic measures of interest included insulin resistance, fasting glucose, hemoglobin A1C (HbA1c), inflammatory markers, adipokines, lipid profiles, and body mass index (BMI). Title, abstract, and full-text screening were performed by three reviewers with subsequent narrative synthesis.

RESULTS

3484 studies were initially identified, with 160 meeting inclusion criteria. 129 studies were included solely due to reporting of pre- and post-operative BMIs. The remaining 31 studies (n = 1675 participants) examined other metabolic outcomes and included various categories of OSA surgery: soft tissue surgery alone (58.1%) or in combination with nasal or skeletal surgery (32.3%), upper airway stimulation (6.5%), and skeletal surgery alone (3.2%). Within the 31 studies, the most commonly examined metabolic outcomes were C-reactive protein (CRP, 45.1%), lipid profiles (45.1%), TNF-α and IL-6 (25.8%), fasting glucose (25.8%), leptin (22.6%), HbA1c (19.4%), and insulin resistance (16.1%). Most studies demonstrated improvements in CRP, TNF-α, IL-6, and leptin, but no changes in fasting glucose, insulin resistance, or HbA1c. None of the included studies examined BMI as a primary outcome.

CONCLUSIONS

The existing literature suggests that OSA surgery is associated with improvements in inflammatory markers. The paucity of studies on the metabolic outcomes of upper airway stimulation and skeletal surgery highlights knowledge gaps for these OSA surgeries.

Correlation of polysomnography data and inflammatory markers after sleep surgery

BACKGROUND

The occurrence of hypoxia during apneas and hypopneas is associated with the triggering of an inflammatory response.

OBJECTIVES

This study investigates the alterations in polysomnography (PSG) data, inflammatory markers, and the correlation between these alterations in patients undergoing sleep surgery.

METHODS

The data of 66 patients who underwent drug-induced sleep endoscopy followed by appropriate sleep surgery, with follow-up PSG performed at 3 to 6 months postoperatively, were retrospectively analyzed. Additionally, correlations with inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), eosinophil-to-lymphocyte ratio (ELR) and systemic immune-inflammation index (SII), were investigated.

RESULTS

Comparison of preoperative and postoperative inflammatory markers revealed statistically significant reductions in NLR, PLR, and SII (p < 0.001, p = 0.023, p = 0.026, respectively). Significant positive correlations were identified between AHI and NLR (p = 0.001, r = 0.400), PLR (p = 0.001, r = 0.415) and SII (p = 0.010, r = 0.392). Similarly, a significant positive correlation was observed between supine AHI and NLR (p = 0.035, r = 0.379), PLR (p = 0.008, r = 0.325), and SII (p = 0.030, r = 0.367). The time spent with SaO2 below 90% was found to be significantly and positively correlated with NLR (p = 0.023, r = 0.279), PLR (p = 0.027, r = 0.272), and SII (p = 0.033, r = 0.256).

CONCLUSIONS AND SIGNIFICANCE

A correlation was observed between the postoperative decrease in SII, NLR, and PLR values and PSG data in patients.

Association of vertigo with adult obstructive sleep apnea: A systematic review and meta-analysis

BACKGROUND

Several studies have demonstrated a relationship between vertigo and obstructive sleep apnea (OSA) in adults. This review examined the association between vertigo and OSA and investigated the effects of OSA treatment on vestibular function.

METHODS

Searches were conducted in PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science databases. Two authors independently searched the databases up to November 2023. Meta-analysis of caloric test, cervical vestibular evoked myogenic potential (cVEMP), and ocular vestibular evoked myogenic potential (oVEMP), between adults with and without OSA was done.

RESULTS

Overall, 28 studies were identified, and most of which focused on vestibular dysfunction in the OSA group. Compared with controls, adults with OSA had an increased risk of abnormal caloric test results (odds ratio [OR] = 4.8), absence of cVEMP (OR = 7.9), absence of oVEMP (OR = 6.2), decreased n1p2 amplitude (standardized mean difference [SMD] = -0.78), decreased p1n1 amplitude (SMD = -0.92), decreased p1n1 interval (SMD = -2.37) in cVEMP testing and prolonged n1 latency (SMD = 0.81) and decreased p1n1 amplitude (SMD = -0.51) in oVEMP testing. Three population-based studies implied a high risk of vertigo in adult OSA, although not statistically significant (OR = 2.53, 95 % confidence interval = 0.97 to 6.61). According to 3 studies, OSA is relatively prevalent among patients with vertigo. Another 3 studies regarding OSA treatment on vestibular functions revealed inconsistent findings.

CONCLUSION

Adults with OSA exhibit abnormalities in caloric, cVEMP, and oVEMP test results, indicating impairments in the semicircular canal, saccule, and utricle.

Efficacy of adenotonsillectomy on pediatric obstructive sleep apnea and related outcomes: A narrative review of current evidence

This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA.

Potential Diagnostic and Monitoring Biomarkers of Obstructive Sleep Apnea-Umbrella Review of Meta-Analyses

Obstructive sleep apnea (OSA) is a prevalent, underdiagnosed disease that imposes a significant impact on the health and wellbeing of patients and a financial burden on individuals, their families, and society. Development of new methods of testing other than an overnight sleep study, such as measurement of serum or plasma biomarkers, may provide an easier diagnostic process to identify patients with OSA and allow earlier initiation of treatment, which might prevent serious comorbidities. We conducted a systematic review and quality assessment of available meta-analyses regarding potential diagnostic and monitoring biomarkers of obstructive sleep apnea. A total of 14 sets of candidate biomarkers displayed differences in levels or concentrations in OSA patients compared to non-OSA controls, and decreased after OSA treatment: CRP, IL-6, TNF-α, Il-8, HCY, ICAM-1, VCAM-1, VEGF, TC, LDLc, HDLc, TG, leptin, MDA, ALT, AST, IGF-1, adiponectin, and cortisol. This review summarizes the evidence for OSA-associated potential biomarkers and demonstrates that the quality of available studies, as measured by AMSTAR2, is often low and associated with a high risk of bias.

A Case-Control Study on the Changes in High-Sensitivity C-Reactive Protein and Tumor Necrosis Factor-Alpha Levels with Surgical Treatment of OSAS

Obstructive sleep apnea syndrome (OSAS) is a common but underdiagnosed condition with significant health and economic implications for society. Inflammatory mediators are proposed to be associated with the presence and severity of OSAS and contribute to morbidity and mortality. This paper details a prospective non-randomized case control study of a cohort of subjects, who underwent surgical treatment of OSAS and were enrolled to assess the sleep parameters and blood levels of selected inflammatory markers at pre-operative and post-operative time points, also comparing them to the levels in a control group. A total of 25 study subjects and 18 control subjects were enrolled. Median values and interquartile range (IQR) of the apnea-hypopnea index (AHI) in the study group pre-operatively and post-operatively were 34 (18.5-45.5) and 13.3 (7.5-27.3), while in the control group 1.4 (1.0-2.1) per hour. The mean (IQR) hs-CRP levels (mg/L) were 1.782 (0.941-5.594) and 1.980 (0.990-5.445) in the study group, pre-operatively and post-operatively, respectively, while 0.891 (0.767-1.436) in the control group. The mean (IQR) TNF-α levels (pg/mL) were 7.999 (6.137-9.216) and 6.614 (5.534-7.460) pre-and post-operatively, respectively, and were 6.000 (5.026-6.823) in the control group. Results demonstrated that both inflammatory markers, hs-CRP and TNF-α, are higher in subjects with OSAS compared to the controls, and their levels decrease, but are still higher than the controls, after successful surgical treatment. Further analysis including the body mass index and age demonstrated that these changes were significant for TNF-α, but not hs-CRP.

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

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, 2022.