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Is There an Effect of Obstructive Sleep Apnea Syndrome on Oxidative Stress and Inflammatory Parameters in Patients With Craniofacial Anomalies?

Driessen, Caroline MD, PhD*; Plomp, Raul G. MD*; van der Spek, Peter J. PhD; Ince, Can PhD; Kulik, Wim PhD§; Mathijssen, Irene MJ. MD, PhD*; Joosten, Koen FM. MD, PhD

doi: 10.1097/SCS.0b013e3182a41c05
Original Articles

Abstract: The aim of this study was to test the hypothesis that obstructive sleep apnea syndrome (OSAS) exhibits oxidative stress and inflammation in patients who have a congenital, craniofacial anomaly.

This prospective, cross-sectional cohort study included ambulant sleep study data to asses OSAS in patients with syndromic craniosynostosis and Treacher Collins syndrome. Laboratory analyses were performed including malondialdehyde, tumor necrosis factor α (TNF-α), interleukin 6, and high-sensitivity C-reactive protein.

Forty-eight patients were included; 11 were adults; 37 were children. The patients’ body mass indexes were normal, with a median (SD) of 0.7 (−1.82 to 2.48) in children and 20.5 (15.2–29.4) in adults. Obstructive sleep apnea syndrome was diagnosed in 23 of 48 patients. It was mild (median obstructive apnea–hypopnea index [oAHI], 2.3; oxygenation-desaturation index [ODI], 0.9) in 16 patients and moderate/severe in 7 patients (median oAHI, 10.8; ODI, 5.0). Neither oxidative stress nor inflammation had a correlation with the oAHI and ODI. Only TNF-α was found significantly higher in both the OSAS and non-OSAS groups compared with the reference values (median, 15.1 pg/mL and 12.3 pg/mL versus 4.05 [0.0–8.1 pg/mL], P < 0.001 and P < 0.001, respectively).

Based on our findings we conclude that (mainly mild) OSAS, oxidative stress, as well as high-sensitivity C-reactive protein and interleukin 6 levels are not abnormal in the day time in a population of nonobese patients with a craniofacial anomaly. The increased level of TNF-α cannot be explained by OSAS. Future research should focus on mapping chronobiologic changes for further interpretation of the results.

From the Departments of *Plastic, Reconstructive and Hand Surgery, †Bioinformatics, ‡Intensive Care Medicine, and §Department of Biochemistry, Academic Medical Center, Amsterdam, and ∥Pediatrics, Dutch Craniofacial Centre, Erasmuc Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands.

Received May 28, 2013.

Accepted for publication July 5, 2013.

Address correspondence and reprint requests to Dr. Caroline Driessen, Erasmus MC Sophia Children’s Hospital, Department of Plastic and Reconstructive Surgery, Sk-1202, PO 2060, 3000 CB Rotterdam, The Netherlands; E-mail: c.driessen@erasmusmc.nl

This study was funded by Stichting Hoofdzaak, Erasmus Trust foundation and NutsOhra Foundation.

The authors report no conflicts of interest.

Dr Driessen conceptualized and designed the study, included the patients, assessed the sleep studies, performed the statistical analyses, and drafted the manuscript.

Dr Plomp conceptualized and designed the study, included the patients, assessed the sleep studies, performed the statistical analyses, and drafted the manuscript.

Dr van der Spek conceptualized and designed the study, was involved in the interpretation of data, brainstormed on the topics of discussion, and critically reviewed and approved the final version.

Dr Ince conceptualized and designed the study, was involved in the interpretation of data, brainstormed on the topics of discussion, and critically reviewed and approved the final version.

Dr Kulik conceptualized and designed the study, was involved in the interpretation of data, brainstormed on the topics of discussion, and critically reviewed and approved the final version.

Dr Mathijssen conceptualized and designed the study, supervised the data collection, was involved in the interpretation of data, assessed and treated the patients, gave major input for the focus of the study and discussion, and performed multiple thorough reviews before finally approving the manuscript.

Dr Joosten was involved in conceptualizing and designing the study and interpreting the sleep studies, supervised the data collection, was also involved in writing the manuscript, and performed multiple reviews and a final critical review.

© 2013 by Mutaz B. Habal, MD.