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Sleep Med. 2013 Feb;14(2):172-6. doi: 10.1016/j.sleep.2012.11.011. Epub 2013 Jan 11.

Effect of adenotonsillectomy on c-reactive protein levels in children with obstructive sleep apnea: a meta-analysis.

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American Family Children's Hospital, Madison, WI, USA.



Children with obstructive sleep apnea syndrome (OSAS) have increased systemic inflammation, as assessed by c-reactive protein (CRP), and are at risk for substantial end-organ damage. Previous studies assessing the effect of adenotonsillectomy (T&A) on CRP in children with OSAS have yielded conflicting results. Therefore, the purpose of the current investigation was to perform a meta-analysis of the effect of T&A on CRP in children with OSAS and explore possible moderating factors.


Multiple databases (PubMed, CINAHL, and Cochrane) were searched for relevant studies. Effective size was calculated with standardized mean differences (SMD) and analyzed with random-effects model. Moderators were examined with mixed-effects models.


Overall, T&A significantly reduced CRP (SMD=-0.79, 95% CI -1.33 to -0.25). We found significant between-study heterogeneity (Cochran's Q=54.6, df=7, p<0.001; I2=90.7%, 95% CI 77.5-98.2%; and H2=10.7, 95% CI 4.5-55.7). We did not find evidence of publication bias or significant effects of tested moderators (study year, study size, age, gender, obesity, apnea-hypopnea index, oxygen nadir, pre-surgical CRP, follow-up duration).


The results of the current study indicate that T&A significantly reduces CRP levels in children with OSAS. Despite the presence of significant between-study heterogeneity, we did not identify any significant moderating factors.

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