Affiliation:
1. Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
2. Department of Otorhinolaryngology—Head and Neck Surgery Singapore General Hospital Sinagapore Singapore
3. SingHealth Duke‐NUS Sleep Centre Sinagapore Singapore
Abstract
ObjectiveTo assess whether adenotonsillectomy improves levels of inflammatory and cardiometabolic markers in children with polysomnographically diagnosed obstructive sleep apnea (OSA).Data SourcesTwo authors independently searched PubMed, Embase, and Cochrane databases up to August 16, 2022, for studies relating to pre‐ and post‐operative levels of serum markers in pediatric patients undergoing adenotonsillectomy.Review MethodsData were extracted from included articles into a structured proforma. Meta‐analyses of the standardized mean difference (SMD) were conducted in random‐effects models. We calculated the probability of benefit (POB) and number needed to treat (NNT) for outcomes that demonstrated a statistically significant effect after adenotonsillectomy. The primary outcomes were changes in serum markers including C‐reactive protein (CRP), high‐sensitivity CRP (hs‐CRP), Insulin‐like growth factor 1 (IGF‐1), interleukin‐10 (IL‐10), interleukin‐6 (IL‐6), tumor necrosis factor‐alpha (TNF‐α), Brain natriuretic peptide (BNP), insulin, glucose, total cholesterol, triglyceride, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL).ResultsWe screened 1616 studies and included 26 studies with 1331 participants. Meta‐analysis was performed on 20 of the included studies. Adenotonsillectomy was associated with a significant decrease in insulin levels (SMD = −0.322, 95% Confidence Interval (CI) = −0.583 to −0.061), CRP (SMD = −0.946, 95% CI = −1.578 to −0.314), and BNP (SMD = −1.416, 95% CI = −2.355 to −0.477) and significant increase in levels of IGF‐1 (SMD = 0.691, 95% CI = 0.207 to 1.176). There were no significant changes in levels of triglyceride, total cholesterol, TNF‐α, LDL, HDL, glucose, IL‐10, and IL‐6.ConclusionIn children with polysomnographically diagnosed OSA, adenotonsillectomy was associated with improvements in serum biomarkers, comprising lower CRP, insulin, and BNP, and higher IGF‐1. Laryngoscope, 134:3030–3037, 2024