Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

Kang, Kun‐Tai; Yeh, Te‐Huei; Hsu, Ying-Shuo; Ko, Jenq‐Yuh; Lee, Chia‐Hsuan; Lin, Ming‐Tzer; Hsu, Wei‐Chung

doi:10.1002/lary.29212

Cited by 10 publications

(9 citation statements)

References 76 publications

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“…In this meta‐analysis, we were unable to clarify the factors associated with cytokine changes after sleep surgery. Our previous meta‐analysis identified that OSA improvement was associated with C‐reactive protein changes after sleep surgery 25 . By contrast, according to our analysis, OSA improvement was not significantly associated with cytokine changes.…”

Section: Discussioncontrasting

confidence: 64%

“…Several surgical procedures, including nasal surgery, 52,53 uvulopalatopharyngoplasty, 54 multilevel surgery, 55,56 maxillomandibular advancement, 57,58 tracheostomy, 59 and hypoglossal nerve stimulation, 60,61 have been introduced based on patients' anatomy, and they have different surgical outcomes. Our recent meta‐analysis in 2021 revealed that sleep surgery for OSA resulted in a significant reduction of C‐reactive protein levels in adults 25 …”

Section: Discussionmentioning

confidence: 99%

“…Moreover, surgical modification of upper airways may improve cardiovascular and inflammatory parameters. A recent meta‐analysis confirmed that sleep surgery for OSA resulted in a significant reduction in C‐reactive protein levels in adults 25 . However, to the best of our knowledge, a meta‐analysis is lacking on the effects of sleep surgery on inflammatory cytokines in adults with OSA.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

et al. 2022

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Objective To evaluate whether sleep surgery is associated with inflammatory cytokine changes. This study hypothesizes cytokines may change after surgery in adult obstructive sleep apnea (OSA). Study Design Systematic review and meta‐analysis. Methods The study protocol was registered on PROSPERO (CRD42020154425). Two authors independently searched PubMed, Embase, and Cochrane review databases from their inception to June 2021. The keywords used were sleep apnea, inflammatory markers, cytokines, and surgery. The effects of sleep surgery on the apnea–hypopnea index (AHI) and inflammatory cytokines were evaluated using a random‐effects model. Both mean difference (MD) and standardized mean difference (SMD) of the changes in cytokines were calculated. Results Nine studies with 235 adults were included (mean age: 43 years; 82% were men). After sleep surgery, AHI significantly reduced by −11.3 events/h (95% confidence interval [CI], −15.8 to −6.9). In total, 8 and 6 studies were pooled for examining tumor necrosis factor‐alpha (TNF‐α) and interleukin‐6 (IL‐6) levels, respectively. Sleep surgery significantly reduced TNF‐α levels, with an MD of −2.8 pg/ml (95% CI, −5.1 to −0.6) and an SMD of −0.56 (95% CI, −0.85 to −0.27). Furthermore, sleep surgery reduced IL‐6 levels, with an MD of −0.6 pg/ml (95% CI, −1.0 to −0.2) and an SMD of −0.66 (95% CI, −0.89 to −0.43). No covariates were identified to be correlated with cytokine changes in subgroup and meta‐regression analyses. Funnel plots showed possible publication bias in current data. Conclusions In adults, OSA treatment with sleep surgery improves inflammatory cytokines. Laryngoscope, 132:2275–2284, 2022

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

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“…Before the procedure, an average of 0.25mg / L was measured, and 30 days after surgery, 0.12mg / L, a decrease of 0.13mg / mL. Usually in human beings with obstructive sleep syndrome, there are increased values of C-reactive protein, with a significant reduction in the levels of this biomarker in adult patients after surgical treatment (Kang et al, 2020). Although brachycephalic dogs do not develop an inflammatory condition as expressive chronic as humans with anterior airway obstruction, rhinoplasty with diode laser was able to decrease C-reactive protein levels.…”

Section: Discussionmentioning

confidence: 99%

“…It is suggested that in human patients with obstructive sleep syndrome, age is a risk factor for the disease, since it is diagnosed regularly in adult patients (Kang et al, 2020). In brachycephalic dogs, the severity of the condition is directly linked to the obstructive components, and clinical manifestation is also common in very young animals due to the intense selection to which they were submitted.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of plasmatic levels of CK-MB and C-Reactive Protein in brachicephalic dogs who have narin stenosis before and after diode laser rhinoplasty

Junior

Duarte²,

Santos³

et al. 2021

RSD

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To evaluate the protective effect of rhinoplasty with diode laser on the cardiovascular system and in the reduction of the inflammatory state, CK-MB and PCR measurements were performed before and 30 days after the surgical procedure. Rhinoplasty using the diode laser promoted a significant reduction in plasma CK-MB and PCR levels, 30 days after its completion. No association was found between the pre-surgical plasma concentration of CK-MB and CRP and the degree of stenosis of the nostrils, race, age, sex and weight of the animals. A significant reduction in CK-MB was observed in dogs with severe stenosis, French Bulldog, one year old and over four years old, male and between 10 and 20 kg. Animals with severe stenosis, of the Pug breed, weighing less than 10 kg and three years of age exhibited a significant decrease in serum CRP values after surgery. As a result, the degree of stenosis of the nostrils, the breed, age, sex and weight of the animals did not influence the plasma concentration of NTpro-BNP, CK-MB and PCR in brachycephalic dogs. Rhinoplasty with diode laser has been shown to be effective in reducing the plasma concentration of the natriuretic peptide CK-MB and CRP in dogs with brachycephalic syndrome, showing that the procedure has a protective effect on the cardiovascular function of these animals and is also effective in reducing inflammatory biomarkers.

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Improved Inflammatory and Cardiometabolic Profile After Soft-Tissue Sleep Surgery for Obstructive Sleep Apnea

Yeo

Koh

Tan

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceObstructive sleep apnea (OSA) is associated with a rise in serum inflammatory markers, which may be attenuated by sleep surgery.ObjectiveTo evaluate whether sleep surgery was associated with improved levels of proinflammatory markers in adults with OSA.Data SourcesTwo authors independently searched Cochrane, Embase, and PubMed databases from inception through June 14, 2022.Study SelectionTwo authors searched the Cochrane, Embase, and PubMed databases for studies comparing preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery.Data Extraction and SynthesisData were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. To ensure relevance to clinicians and patients, the probability of benefit and number needed to treat were calculated for outcomes that demonstrated a statistically significant effect after sleep surgery.Main Outcomes and MeasuresThe primary outcome was the preoperative and postoperative levels of serum biomarkers in patients undergoing sleep surgery, including C-reactive protein (CRP), glucose, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and interleukin-6 (IL-6). Data analysis was performed from April to May 2022.ResultsOf the 3218 studies screened, 26 studies with 1187 patients (mean [SD] age, 42.8 [11.1] years; 932 [78.5%] men and 255 [21.5%] women) were included. Soft-tissue sleep surgery was associated with a large decrease in CRP (SMD, −0.377; 95% CI, −0.617 to −0.137), total cholesterol (SMD, −0.267; 95% CI, −0.417 to −0.116), LDL (SMD, −0.201; 95% CI, −0.344 to −0.058), IL-6 (SMD, −1.086; 95% CI, −1.952 to −0.221), tumor necrosis factor-α (SMD, −0.822; 95% CI, −1.617 to −0.027), triglyceride (SMD, −0.186; 95% CI, −0.301 to −0.071), and leptin (SMD, −0.519; 95% CI, −0.954 to −0.083) in patients with OSA. Meta-regression highlighted that increased age, higher preoperative score for cumulative sleep time percentage with oxyhemoglobin saturation less than 90% (CT90), and greater change in CT90 postoperatively were associated with a greater decrease in serum CRP levels after soft-tissue sleep surgery. A greater reduction in apnea hypopnea index (AHI) was strongly associated with a greater reduction in total cholesterol and LDL. A greater reduction in body mass index and AHI were also associated with a greater increase in HDL.Conclusions and RelevanceThe findings of this systematic review and meta-analysis of 26 studies suggest that sleep surgery is associated with decreased levels of CRP, total cholesterol, LDL, triglyceride, IL-6, leptin, and TNF-α, which may improve the inflammatory and cardiometabolic profile of patients who undergo sleep surgery.

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Effect of Sleep Surgery on C‐Reactive Protein Levels in Adults With Obstructive Sleep Apnea: A Meta‐Analysis

Cited by 10 publications

References 76 publications

Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

Effect of Sleep Surgery on Inflammatory Cytokines in Adult Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

Evaluation of plasmatic levels of CK-MB and C-Reactive Protein in brachicephalic dogs who have narin stenosis before and after diode laser rhinoplasty

Improved Inflammatory and Cardiometabolic Profile After Soft-Tissue Sleep Surgery for Obstructive Sleep Apnea

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