Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy

Abstract

The objective of the present study was to investigate the effect of transoral endoscopic adenoidectomy on peripheral blood T lymphocyte subsets in pediatric patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its treatment strategy. Ninety-eight pediatric patients with adenoidal hypertrophy associated with OSAHS admitted to the Department of Otolaryngology, Xuzhou Children's Hospital were selected. After admission, patients received perfected 24 h polysomnogram monitoring, routine blood examination, fasting blood biochemistry examination, T-lymphocyte subset count, 24 h ambulatory blood pressure monitoring, and nasopharyngeal computed tomography. After patients were diagnosed with adenoidal hypertrophy associated with OSAHS, they underwent transoral endoscopic adenoidectomy with a power microdebrider. Patients were evaluated at 3-, 6- and 12-week follow-up visits. The CD3+, CD4+, and CD8+ T-cell counts, CD4+/CD8+ T lymphocyte ratio, and changes of 24 h ambulatory blood pressure before and after surgery were recorded. After the 6-week follow-up visit, the mean CD4+ T lymphocyte count in patients was increased significantly compared with that before surgery, the CD4+/CD8+ T lymphocyte ratio increased gradually, and the differences were statistically significant (P<0.05). The frequency of nocturnal awakening of patients was decreased significantly after surgery and the duration of nocturnal sleep was extended significantly (P<0.05). Through analysis of the preoperative and postoperative clinical data of pediatric patients, the CD4+/CD8+ T lymphocyte ratio was negatively correlated with mean arterial pressure (MAP) (r=−1.06, P=0.003). In conclusion, adenoidectomy can significantly decrease the MAP in pediatric patients with OSAHS and increase the duration of nocturnal sleep. The peripheral blood CD4+/CD8+ T lymphocyte ratio in pediatric patients was significantly negatively correlated with MAP.

The efficacy of cryogenic plasma tonsillectomy in the treatment of obstructive sleep apnea‐hypopnea syndrome in children: A meta‐analysis

“…Several studies have shown that cryogenic plasma‐assisted surgical treatment is more effective than traditional methods, with lower postoperative pain and no influence on patients' lung function and immune function 6,22–24 . Similarly, adenoidectomy is effective in patients with OSAHS, and transoral endoscopic adenoidectomy can also reduce mean arterial pressure and prolong nighttime sleep in patients with OSAHS 25–27 . In conclusion, cryogenic plasma‐assisted surgery has the advantages of minor trauma, less bleeding, faster recovery, and less postoperative pain than traditional surgery and therefore plays a vital role in surgical treatment 14…”

“…6,[22][23][24] Similarly, adenoidectomy is effective in patients with OSAHS, and transoral endoscopic adenoidectomy can also reduce mean arterial pressure and prolong nighttime sleep in patients with OSAHS. [25][26][27] In conclusion, cryogenic plasmaassisted surgery has the advantages of minor trauma, less bleeding, faster recovery, and less postoperative pain than traditional surgery and therefore plays a vital role in surgical treatment. 14 This study systematically evaluated the effectiveness and safety of cryo-plasma tonsillectomy for OSAHS.…”

Efficacy of Low-Temperature Plasma-Assisted Unilateral/Bilateral Tonsillectomy and Adenoidectomy in Children with Obstructive Sleep Apnea Hypopnea Syndrome

“…Adenoidectomy is another widely used method in treatment of OSAHS. Yang et al reported that transoral endoscopic adenoidectomy decreased the mean arterial pressure and increased the duration of nocturnal sleep of OSAHS patients [ 30 ]. In another study, Ding et al demonstrated that a combination of adenoidectomy, tonsillectomy, and soft palate-pharyngoplasty was effective to enlarge the anteroposterior diameter and transverse diameter of the isthmus faucium to achieve better efficacy in OSAHS patients [ 31 ].…”

Long-Term Effects of Adenotonsillectomy on Growth and Symptoms in Childhood

“…20,21) Reduction in tumor necrosis factor-α (TNG-α), proinflammatory cytokine, and increased CD4+/CD8+ T lymphocyte ratio after adenotonsillectomy was also reported. 22,23) However, most of the studies on growth, symptom and laboratory changes after tonsillectomy included small number of patients and short-term follow-up periods, and there have been few studies on long-term effects on growth or symptom changes.…”