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

Abstract

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.

Long-term intermittent hypoxia in mice induces inflammatory pathways implicated in sleep apnea and steatohepatitis in humans

“…It would be worthwhile to increase the number of biological replicates in mice to fully characterize the conserved signature between mice and humans. TNF-α has been described in various inflammatory diseases including NASH and OSA 31 , 32 , 33 while little is known about IL20 and LIF in these pathologies. 34 IL20 has been implicated in several inflammatory diseases 35 and ongoing clinical trials are investigating the potential therapeutic effects of anti-IL20 in psoriasis and rheumatoid arthritis (NCT01038674, NCT01261767) making IL20 an interesting target to explore in the context of OSA and NASH.…”

Sleep and cardiovascular disease

“…Inflammatory markers including CRP are increased in OSA [ 91 ] and inflammatory (CRP, IL-6, and TNF-α) and cardiometabolic profiles (total cholesterol, LDL, triglyceride) as well as leptin are improved following soft-tissue surgery for OSA [ 92 ]. Likewise, the neutrophil-to-lymphocyte ratio (NLR), a measure of subclinical systemic inflammation, is significantly reduced in patients using CPAP [ 93 ].…”

Surgical Outcomes for Obstructive Sleep Apnea in Korea

“…Numerous studies have reported postoperative improvement of such clinical outcomes as symptoms, cardiovascular risk, quality of life, and mortality [10]. However, except for some primary candidates for surgery and a few surgical procedures, such as MMA or tracheostomy, most surgical procedures for OSA are generally not recognized as curative treatments, because the possibility of cure is relatively low and the outcome after surgery is difficult to predict [2,7,9].…”