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.