The Effect of Surgical Treatment of Obstructive Sleep Apnea Syndrome on the Plasma TNF-.ALPHA. Levels

Abstract

Obstructive sleep apnea syndrome (OSAS) is defined as intermittent complete or partial upper airway obstruction during sleep, causing mental and physical effects. Both the local and systemic inflammation observed in OSAS induce certain potent pro-inflammatory mediators, which may contribute to the development of cardiovascular consequences. The present study was designed to evaluate the plasma levels of TNF-α , which is one of the known pro-inflammatory cytokines, in patients with OSAS and to assess the effect of surgical treatment on the levels of TNF-α levels. Twenty seven patients diagnosed to have OSAS, 7 non-apneic patients with chronic tonsillitis (non-OSAS patients), and 4 healthy subjects were enrolled in this study. Blood samples were collected one week preoperatively and postoperatively, and the plasma TNF-α levels were measured using high-sensitivity ELISA. The plasma TNF-α levels in patients with OSAS were significantly elevated in comparison to normal healthy subjects. In contrast, there was no difference between the patients with non-OSAS and healthy subjects. Moreover, the surgical treatment to enlarge the upper airway in patients with OSAS significantly decreased the levels of TNF-α levels. Surgical treatment of patients with OSAS reduces the plasma TNF-α levels, thereby ameliorating the systemic inflammation and preventing the development of cardiovascular consequences.

Biochemical Regulation of Sleep and Sleep Biomarkers

“…50 Furthermore, surgical treatment of obstructive sleep apnea reduces plasma levels of TNF as well as sleepiness. 51 The link between pathology, cytokine levels, and sleep suggest that some primary sleep disorders such as sleep apnea or insomnia are chronic inflammatory disorders.…”

Lifestyle modifications and the resolution of obstructive sleep apnea syndrome: a case report

“…13,[40][41][42][43] Research has shown other inflammatory markers to be increased in patients with OSAS, such as interleukin-6, interleukin-8, tumor necrosis factor-α, leptin, resistin, adhesion molecules, and free radicals. 3,6,40,[44][45][46] Elevated levels of these same inflammatory markers have also been implicated with increased risk of cancer death, cardiovascular and cerebrovascular disease, diabetes, and hypertension. 6,13,40,41,[44][45][46] Patients with OSAS also express an inflammatory spike following sleep as demonstrated by increased nasal pentane and nitric oxide levels.…”

“…3,6,40,[44][45][46] Elevated levels of these same inflammatory markers have also been implicated with increased risk of cancer death, cardiovascular and cerebrovascular disease, diabetes, and hypertension. 6,13,40,41,[44][45][46] Patients with OSAS also express an inflammatory spike following sleep as demonstrated by increased nasal pentane and nitric oxide levels. 47 Pentane is a nonspecific marker of inflammation and is the most common product of cell membrane polyunsaturated fatty acid peroxidation by free radicals.…”

Cardiovascular Morbidity in Obstructive Sleep Apnea

“…All these findings were markedly improved or reversed by treatment with CPAP (44)(45)(46). Elevated systemic TNF-a levels were found in OSA, and improved after treatment (47), whereas in contrast with such findings, no evidence of increased TNF-a levels was found in a large group of patients with OSA and control subjects (n 5 155) (48), suggesting that the increased expression and activity of this cytokine may be restricted to localized effects within the endothelial surface. Notwithstanding these findings, a recent publication in the Journal (49) suggests that not only TNF-a levels are increased but they correlate with the degree of sleepiness and the severity of hypoxia (49).…”