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Effect of modern surgical treatment on the inflammatory/anti-inflammatory balance in patients with obstructive sleep apnoea

Published online by Cambridge University Press:  23 May 2017

M Binar ,
T M Akcam ,
O Karakoc ,
R I Sagkan ,
U Musabak  and
M Gerek
M Binar*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
T M Akcam
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Medical Park Hospital, Ankara, Turkey
O Karakoc
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
R I Sagkan
Affiliation:
Department of Immunology, Gulhane Medical School, Ankara, Turkey
U Musabak
Affiliation:
Department of Immunology, Gulhane Medical School, Ankara, Turkey
M Gerek
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
*
Address for correspondence: Dr Murat Binar, Gulhane Egitim Arastırma Hastanesi, KBB AD, Etlik, 06018, Kecioren, Ankara, Turkey Fax: +90 312 304 5700 E-mail: mbinar4@yahoo.com
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Abstract

Objective:

To investigate the inflammatory/anti-inflammatory cytokine balance – T helper 1/T helper 2 ratios – in obstructive sleep apnoea patients, before and after treatment.

Methods:

Twenty-eight patients received continuous positive airway pressure treatment and 29 patients who could not tolerate continuous positive airway pressure were scheduled for surgery. Serum levels of interleukins 2, 4 and 10, tumour necrosis factor-alpha, and interferon gamma were analysed by enzyme-linked immunosorbent assays before and three months after treatment.

Results:

The success rate of surgical treatment was 65.5 per cent. Mean compliance for the continuous positive airway pressure group was 40.9 per cent. The apnoea/hypopnoea index significantly decreased in both groups after treatment (p < 0.001). The interferon gamma/interleukin-4 ratio decreased following surgical treatment (p = 0.014), and the interleukin-2/interleukin-4 ratio decreased after treatment in 57 patients in the overall cohort (p = 0.032).

Conclusion:

After treatment for obstructive sleep apnoea, some ratios reflecting T helper 1/T helper 2 cytokine balance favoured the T helper 2 direction, suggesting a shift to an anti-inflammatory state. Successful surgery and better continuous positive airway pressure compliance can help ameliorate inflammation in obstructive sleep apnoea patients, which may reduce associated morbidities.

Keywords

Obstructive Sleep ApneaInflammationSurgical ProceduresOperativeContinuous Positive Airway PressureCytokines

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 8 , August 2017 , pp. 719 - 727
Copyright
Copyright © JLO (1984) Limited 2017 

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Footnotes

Presented at the 26th Congress of the European Rhinologic Society, in conjunction with the 35th Congress of the International Society of Inflammation and 17th Congress of the International Rhinologic Society (‘ERS-ISIAN-IRS 2016 Congress’), 3–7 July 2016, Stockholm, Sweden.

References

1 Garvey, JF, Taylor, CT, McNicholas, WT. Cardiovascular disease in obstructive sleep apnoea syndrome: the role of intermittent hypoxia and inflammation. Eur Respir J 2009;33:1195–205CrossRefGoogle ScholarPubMed
2 Dempsey, JA, Veasey, SC, Morgan, BJ, O'Donnell, CP. Pathophysiology of sleep apnea. Physiol Rev 2010;90:47–112 Google Scholar
3 Semenza, GL. Hypoxia-inducible factor 1: control of oxygen homeostasis in health and disease. Pediatr Res 2001;49:614–17Google Scholar
4 Htoo, AK, Greenberg, H, Tongia, S, Chen, G, Henderson, T, Wilson, D et al. Activation of nuclear factor kappaB in obstructive sleep apnea: a pathway leading to systemic inflammation. Sleep Breath 2006;10:43–50 Google Scholar
5 Ryan, S, Taylor, CT, McNicholas, WT. Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome? Thorax 2009;64:631–6Google Scholar
6 Nadeem, R, Molnar, J, Madbouly, EM, Nida, M, Aggarwal, S, Sajid, H et al. Serum inflammatory markers in obstructive sleep apnea: a meta-analysis. J Clin Sleep Med 2013;9:1003–12Google Scholar
7 Yokoe, T, Minoguchi, K, Matsuo, H, Oda, N, Minoguchi, H, Yoshino, G et al. Elevated levels of C-reactive protein and interleukin-6 in patients with obstructive sleep apnea syndrome are decreased by nasal continuous positive airway pressure. Circulation 2003;107:1129–34Google Scholar
8 Vgontzas, AN, Papanicolaou, DA, Bixler, EO, Kales, A, Tyson, K, Chrousos, GP. Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab 1997;82:1313–16Google Scholar
9 Kataoka, T, Enomoto, F, Kim, R, Yokoi, H, Fujimori, M, Sakai, Y et al. The effect of surgical treatment of obstructive sleep apnea syndrome on the plasma TNF-alpha levels. Tohoku J Exp Med 2004;204:267–72Google Scholar
10 Swain, SL, Bradley, LM, Croft, M, Tonkonogy, S, Atkins, G, Weinberg, AD et al. Helper T-cell subsets: phenotype, function and the role of lymphokines in regulating their development. Immunol Rev 1991;123:115–44Google Scholar
11 Girón-González, JA, Moral, FJ, Elvira, J, García-Gil, D, Guerrero, F, Gavilán, I et al. Consistent production of a higher TH1:TH2 cytokine ratio by stimulated T cells in men compared with women. Eur J Endocrinol 2000;143:31–6Google Scholar
12 Arias, MA, García-Río, F, Alonso-Fernández, A, Hernanz, A, Hidalgo, R, Martínez-Mateo, V et al. CPAP decreases plasma levels of soluble tumour necrosis factor-alpha receptor 1 in obstructive sleep apnoea. Eur Respir J 2008;32:1009–15CrossRefGoogle ScholarPubMed
13 Kohler, M, Ayers, L, Pepperell, JC, Packwood, KL, Ferry, B, Crosthwaite, N et al. Effects of continuous positive airway pressure on systemic inflammation in patients with moderate to severe obstructive sleep apnoea: a randomised controlled trial. Thorax 2009;64:67–73 CrossRefGoogle ScholarPubMed
14 Wu, KM, Lin, CC, Chiu, CH, Liaw, SF. Effect of treatment by nasal continuous positive airway pressure on serum high mobility group box-1 protein in obstructive sleep apnea. Chest 2010;137:303–9Google Scholar
15 Jullian-Desayes, I, Joyeux-Faure, M, Tamisier, R, Launois, S, Borel, AL, Levy, P et al. Impact of obstructive sleep apnea treatment by continuous positive airway pressure on cardiometabolic biomarkers: a systematic review from sham CPAP randomized controlled trials. Sleep Med Rev 2015;21:23–38 Google Scholar
16 Xie, X, Pan, L, Ren, D, Du, C, Guo, Y. Effects of continuous positive airway pressure therapy on systemic inflammation in obstructive sleep apnea: a meta-analysis. Sleep Med 2013;14:1139–50Google Scholar
17 Ishida, K, Kato, M, Kato, Y, Yanagihara, K, Kinugasa, Y, Kotani, K et al. Appropriate use of nasal continuous positive airway pressure decreases elevated C-reactive protein in patients with obstructive sleep apnea. Chest 2009;136:125–9CrossRefGoogle ScholarPubMed
18 Ip, MS, Lam, B, Chan, LY, Zheng, L, Tsang, KW, Fung, PC et al. Circulating nitric oxide is suppressed in obstructive sleep apnea and is reversed by nasal continuous positive airway pressure. Am J Respir Crit Care Med 2000;162:2166–71Google Scholar
19 Harsch, IA, Konturek, PC, Koebnick, C, Kuehnlein, PP, Fuchs, FS, Pour Schahin, S et al. Leptin and ghrelin levels in patients with obstructive sleep apnoea: effect of CPAP treatment. Eur Respir J 2003;22:251–7Google Scholar
20 Guo, Y, Pan, L, Ren, D, Xie, X. Impact of continuous positive airway pressure on C-reactive protein in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath 2013;17:495–503 Google Scholar
21 Baessler, A, Nadeem, R, Harvey, M, Madbouly, E, Younus, A, Sajid, H et al. Treatment for sleep apnea by continuous positive airway pressure improves levels of inflammatory markers – a meta-analysis . J Inflamm (Lond) 2013;10:13 Google Scholar
22 Karamanlı, H, Özol, D, Ugur, KS, Yıldırım, Z, Armutçu, F, Bozkurt, B et al. Influence of CPAP treatment on airway and systemic inflammation in OSAS patients. Sleep Breath 2014;18:251–6Google Scholar
23 Chu, L, Li, Q. The evaluation of adenotonsillectomy on TNF-alpha and IL-6 levels in obese children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol 2013;77:690–4Google Scholar
24 Constantinidis, J, Ereliadis, S, Angouridakis, N, Konstantinidis, I, Vital, V, Angouridaki, C. Cytokine changes after surgical treatment of obstructive sleep apnoea syndrome. Eur Arch Otorhinolaryngol 2008;265:1275–9Google Scholar
25 Berry, RB, Budhiraja, R, Gottlieb, DJ, Gozal, D, Iber, C, Kapur, VK et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597–619 Google Scholar
26 Calvin, AD, Albuquerque, FN, Lopez-Jimenez, F, Somers, VK. Obstructive sleep apnea, inflammation, and the metabolic syndrome. Metab Syndr Relat Disord 2009;7:271–8Google Scholar
27 Minoguchi, K, Tazaki, T, Yokoe, T, Minoguchi, H, Watanabe, Y, Yamamoto, M et al. Elevated production of tumor necrosis factor-alpha by monocytes in patients with obstructive sleep apnea syndrome. Chest 2004;126:1473–9CrossRefGoogle ScholarPubMed
28 Ciftci, TU, Kokturk, O, Bukan, N, Bilgihan, A. The relationship between serum cytokine levels with obesity and obstructive sleep apnea syndrome. Cytokine 2004;28:87–91 Google Scholar
29 Alberti, A, Sarchielli, P, Gallinella, E, Floridi, A, Mazzotta, G, Gallai, V. Plasma cytokine levels in patients with obstructive sleep apnea syndrome: a preliminary study. J Sleep Res 2003;12:305–11CrossRefGoogle ScholarPubMed
30 Vgontzas, AN, Zoumakis, E, Lin, HM, Bixler, EO, Trakada, G, Chrousos, GP. Marked decrease in sleepiness in patients with sleep apnea by etanercept, a tumor necrosis factor-alpha antagonist. J Clin Endocrinol Metab 2004;89:4409–13CrossRefGoogle ScholarPubMed
31 Wagner, H, Hardt, C, Heeg, K, Pfizenmaier, K, Stotter, H, Rollinghoff, M. The in vivo effects of interleukin 2 (TCGF). Immunobiology 1982;161:139–56Google Scholar
32 Sarinc Ulasli, S, Sarıaydın, M, Gunay, E, Halici, B, Celik, S, Koyuncu, T et al. Effects of nondipping pattern on systemic inflammation in obstructive sleep apnea. Sleep Breath 2015;19:1185–90CrossRefGoogle ScholarPubMed
33 Ransom, J, Fischer, M, Mosmann, T, Yokota, T, DeLuca, D, Schumacher, J et al. Interferon-gamma is produced by activated immature mouse thymocytes and inhibits the interleukin 4-induced proliferation of immature thymocytes. J Immunol 1987;139:4102–8Google Scholar
34 de Waal Malefyt, R, Abrams, J, Bennett, B, Figdor, CG, de Vries, JE. Interleukin 10 (IL-10) inhibits cytokine synthesis by human monocytes: an autoregulatory role of IL-10 produced by monocytes. J Exp Med 1991;174:1209–20Google Scholar
35 Dyugovskaya, L, Lavie, P, Lavie, L. Lymphocyte activation as a possible measure of atherosclerotic risk in patients with sleep apnea. Ann N Y Acad Sci 2005;1051:340–50Google Scholar
36 Heeschen, C, Dimmeler, S, Hamm, CW, Fichtlscherer, S, Boersma, E, Simoons, ML et al. Serum level of the antiinflammatory cytokine interleukin-10 is an important prognostic determinant in patients with acute coronary syndromes. Circulation 2003;107:2109–14Google Scholar
37 Potteaux, S, Deleuze, V, Merval, R, Bureau, MF, Esposito, B, Scherman, D et al. In vivo electrotransfer of interleukin-10 cDNA prevents endothelial upregulation of activated NF-kappaB and adhesion molecules following an atherogenic diet. Eur Cytokine Netw 2006;17:13–18 Google ScholarPubMed
38 De Luca Canto, G, Pacheco-Pereira, C, Aydinoz, S, Major, PW, Flores-Mir, C, Gozal, D. Biomarkers associated with obstructive sleep apnea: a scoping review. Sleep Med Rev 2014;23:28–45 Google Scholar
39 Jiang, H, Cao, H, Wang, P, Liu, W, Cao, F, Chen, J. Tumour necrosis factor-alpha/interleukin-10 ratio in patients with obstructive sleep apnoea hypopnoea syndrome. J Laryngol Otol 2015;129:73–8Google Scholar
40 Billiau, A. Interferons and inflammation. J Interferon Res 1987;7:559–67Google Scholar
41 Gately, MK, Warrier, RR, Honasoge, S, Carvajal, DM, Faherty, DA, Connaughton, SE et al. Administration of recombinant IL-12 to normal mice enhances cytolytic lymphocyte activity and induces production of IFN-gamma in vivo. Int Immunol 1994;6:157–67Google Scholar
42 Tam, CS, Wong, M, McBain, R, Bailey, S, Waters, KA. Inflammatory measures in children with obstructive sleep apnoea. J Paediatr Child Health 2006;42:277–82Google Scholar
43 Waters, KA, Mast, BT, Vella, S, de la Eva, R, O'Brien, LM, Bailey, S et al. Structural equation modeling of sleep apnea, inflammation, and metabolic dysfunction in children. J Sleep Res 2007;16:388–95Google Scholar