Urine cysteinyl leukotriene levels in children with sleep disordered breathing before and after adenotonsillectomy.
OBJECTIVE
Obstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA.


METHODS
Children under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO2monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again.


RESULTS
Thirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE4levels decreased from 961.9 (684.8-1438.2) to 708.6 (538.2-1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children.


CONCLUSIONS
Adenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.
Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand. Electronic address: araya221@gmail.com.
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Satdhabudha
Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand; Center of Excellence in Applied Epidemiology, Thammasat University, Pathum Thani, Thailand.
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Sritipsukho
Division of Cell Biology, Department of Preclinical Science, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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Manochantr
Department of Otolaryngology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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Chanvimalueng
Department of Radiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
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Chaumrattanakul
Faculty of Veterinary Medicine, Mahanakorn University of Technology, Bangkok, Thailand.
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Chaumphol
D000233:Adenoidectomy / Q000379:methods; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003545:Cysteine / Q000652:urine*; D005260:Female; D006801:Humans; D017999:Leukotriene E4 / Q000652:urine*; D015289:Leukotrienes / Q000652:urine*; D008297:Male; D009765:Obesity / Q000150:complications; D011379:Prognosis; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery / Q000652:urine*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome
D015415:Biomarkers; D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D017999:Leukotriene E4; D003545:Cysteine
Adenotonsillar hypertrophy; Adenotonsillectomy; Cysteinyl leukotrienes; Leukotriene E4; Obstructive sleep apnea; Sleep disordered breathing