Sleep-Disordered Breathing, Obesity, and Airway Inflammation in Children and Adolescents

Verhulst, Stijn; Aerts, Liselotte; Jacobs, Sarah M.; Schrauwen, Nancy; Haentjens, Dominique; Claes, Rita; Vaerenberg, Hilde; Gaal, Luc F. Van; Backer, Wilfried A. De; Desager, Kristine

doi:10.1378/chest.08-0535

Cited by 68 publications

(43 citation statements)

References 40 publications

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“…4,[23][24] The results we observed in our study are consistent with the current evidence showing elevated cytokines and inflammatory markers in exhaled breath as well as upper airway tissues of OSA patients. 4,[9][10][11][12][13][14][15][16][17]23,[25][26][27][28] Salerno et al and Devouassoux et al detected increased neutrophils and reduced macrophages in the induced sputum of OSA patients. 27,28 The latter study also observed a concurrent higher interleukin-8 concentration in the induced sputum specimen of these patients.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Prior studies that have evaluated the FENO levels in OSA have shown inconsistent results. [7][8][9][10][11][12][13][14][15][16][17] Specifi cally, studies have shown no difference, 8,10 mild increase, 13 or signifi cant increases in FENO 7,9,11,12,14,16,17 compared to controls. Post-vs. pre-sleep FENO was signifi cantly increased in one study 7 but unchanged in another.…”

Section: -4mentioning

confidence: 99%

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Long-Term Continuous Positive Airway Pressure Therapy Normalizes High Exhaled Nitric Oxide Levels in Obstructive Sleep Apnea

Chua

Aboussouan

Minai

et al. 2013

Journal of Clinical Sleep Medicine

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Section: Discussionmentioning

confidence: 99%

Section: -4mentioning

confidence: 99%

Long-Term Continuous Positive Airway Pressure Therapy Normalizes High Exhaled Nitric Oxide Levels in Obstructive Sleep Apnea

Chua

Aboussouan

Minai

et al. 2013

Journal of Clinical Sleep Medicine

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“…The similar extent of local inflammation may explain the comparable distribution pattern of tonsilar lymphocytes in two groups. Consistently, Verhulst et al (8) found that the airway inflammation was not appreciably different in PS and OSAS children. Indeed, the enhanced inflammatory events in local tonsils could be triggered and maintained by snoring and the associated vibration frequencies, with recurring upper airway collapse that promotes soft-tissue damage.…”

Section: The Imbalance Of Cd4 + T-lymphocyte Subsetsmentioning

confidence: 61%

CD4+T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome

Hui

et al. 2015

Pediatr Res

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Background:To characterize the distribution of both tonsillar and circulating CD4 + T-lymphocyte subsets, and to explore their clinical relevance in nonobese children with obstructive sleep apnea syndrome (OSAS). Methods: A total of 53 children who underwent tonsillectomy for either OSAS (n = 25) or primary snoring (PS, n = 28) were prospectively enrolled. Nineteen healthy children without any symptoms were recruited as controls. We quantified the frequencies of CD4 + T-lymphocyte subpopulations using flow cytometry, serum-related cytokines using enzyme-linked immunosorbent assay, and key transcription factors using quantitative polymerase chain reaction (qPCR). results: Tonsillar distributions of CD4 + T-lymphocyte subsets were comparable in the OSAS and PS subjects. The peripheral Th17/Treg ratio was positively correlated to severity as measured by apnea/hypopnea index (AHI), serum C-reactive protein and hypoxia-inducible factor-1α mRNA in the OSAS children (P < 0.05). And AHI was independently associated with the peripheral Th17/Treg ratio (P < 0.05). Furthermore, the response to surgery was associated with a significant reversal of the Th17/Treg imbalance and a concomitant relief of the proinflammatory profile in the OSAS subjects. conclusion: Pediatric OSAS was associated with an altered Th17:Treg balance toward Th17 predominance. The changes in lymphocytic phenotypes that correlated with recurrent intermittent hypoxia in sleep apnea may contribute to the variance in systemic inflammation and downstream morbidities of pediatric OSAS.

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“…82,91 It has also been shown that in overweight children both habitual snoring and obstructive sleep apnoea syndrome are associated with increased airway inflammation, measured as exhaled nitric oxide. 92 However, in the absence of sleep-disordered breathing, the level of nitric oxide was within the normal range, excluding one of the indicated hallmarks of asthma. 92 …”

Section: Obesity and Asthma Control Relationshipmentioning

confidence: 96%

“…92 However, in the absence of sleep-disordered breathing, the level of nitric oxide was within the normal range, excluding one of the indicated hallmarks of asthma. 92 …”

Section: Obesity and Asthma Control Relationshipmentioning

confidence: 96%

Asthma and obesity in childhood: on the road ahead

2010

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Epidemiological data show a link between asthma and obesity, suggesting many different mechanisms that may underlie the association. However, diagnosis of asthma is often self-reported by patients or caregivers. Definition of asthma is crucial, particularly in childhood. Obesity can be associated with symptoms commonly attributed to asthma, such as wheezing, dyspnoea and sleep apnoea. Obese subjects are less fit and may have more frequent bouts of breathlessness on exertion accompanied by an exaggerated symptom perception. Therefore, the link between the two diseases should be analysed by focusing not only on reported diagnosis of asthma but also on objective markers that can better characterize the asthma phenotype. These markers should include lung function parameters, bronchial hyper-reactivity, atopic sensitization and indices of lung inflammation. As we look back and move forward, a multidisciplinary approach is increasingly necessary to understand the complexity of obesity and asthma, keeping in mind that diet and exercise could influence both diagnosis and treatment. In the meantime, in clinical settings, physicians should be cautious about diagnosing asthma in obese children on the basis of selfreported symptoms alone and should confirm the diagnosis by using objective measurements and marker evaluations that can better identify asthma phenotype and exclude overdiagnosis.

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Sleep-Disordered Breathing, Obesity, and Airway Inflammation in Children and Adolescents

Cited by 68 publications

References 40 publications

Long-Term Continuous Positive Airway Pressure Therapy Normalizes High Exhaled Nitric Oxide Levels in Obstructive Sleep Apnea

Long-Term Continuous Positive Airway Pressure Therapy Normalizes High Exhaled Nitric Oxide Levels in Obstructive Sleep Apnea

CD4+T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome

Asthma and obesity in childhood: on the road ahead

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