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Sleep. 2016 Feb 1;39(2):283-91. doi: 10.5665/sleep.5428.

C-reactive Protein as a Potential Biomarker of Residual Obstructive Sleep Apnea Following Adenotonsillectomy in Children.

Author information

1
Sections of Pediatric Sleep Medicine, Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL.
2
Pediatric Pulmonology, Department of Pediatrics, Comer Children's Hospital, The University of Chicago, Chicago, IL.
3
Sleep Disorders Laboratory, University of Thessaly School of Medicine and Larissa University Hospital, Larissa, Greece.
4
Department of Pediatrics, University of Antwerp, Wilrijk, Belgium.

Abstract

STUDY OBJECTIVES:

Adenotonsillectomy (AT) is first-line treatment for pediatric obstructive sleep apnea (OSA), with most children having improvements in polysomnography (PSG). However, many children have residual OSA following AT as determined through PSG. Identification of a biomarker of residual disease would be clinically meaningful to detect children at risk. We hypothesize serum high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker, is predictive of residual OSA following AT.

METHODS:

PSG was performed both preoperatively and postoperatively on children undergoing AT for the diagnosis of OSA. HsCRP serum concentrations were determined in all children pre-AT, and in most children post-AT. Resolution of OSA after AT was defined by a post-AT apnea-hypopnea index (AHI) < 1.5/h total sleep time (TST). Residual OSA was defined as a post-AT AHI > 5/h TST, which is considered clinically significant.

RESULTS:

AT significantly improved the AHI from 15.9 ± 16.4 to 4.1 ± 5.3/h TST in 182 children (P < 0.001). Of 182 children, residual OSA (post-AT AHI > 5) was seen in 46 children (25%). Among children who had hsCRP levels measured pre- and post-AT (n = 155), mean hsCRP levels pre-AT were 0.98 ± 1.91 mg/L and were significantly reduced post-AT (0.63 ± 2.24 mg/dL; P = 0.011). Stratification into post-AT AHI groups corresponding to < 1.5/h TST, 1.5/h TST < AHI < 5/h TST, and AHI > 5/h TST revealed post-AT hsCRP levels of 0.09 ± 0.12, 0.57 ± 2.28, and 1.49 ± 3.34 mg/L with statistical significance emerging comparing residual AHI > 5/h TST compared to post-AT AHI < 1.5/h TST (P = 0.006). Hierarchical multivariate modeling confirmed that pre-AT AHI and post-AT hsCRP levels were most significantly associated with residual OSA.

CONCLUSIONS:

Even though AT improves OSA in most children, residual OSA is frequent. Assessment of post-AT hsCRP levels emerges as a potentially useful biomarker predicting residual OSA.

KEYWORDS:

adenotonsillectomy; biomarker; c-reactive protein; children; obstructive sleep apnea; residual disease

PMID:
26414898
PMCID:
PMC4712390
DOI:
10.5665/sleep.5428
[Indexed for MEDLINE]
Free PMC Article

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