Alterations in circulating T-cell lymphocyte populations in children with obstructive sleep apnea. Sleep 2013 Jun 01;36(6):913-22
Date
06/05/2013Pubmed ID
23729935Pubmed Central ID
PMC3648675DOI
10.5665/sleep.2724Scopus ID
2-s2.0-84878427415 (requires institutional sign-in at Scopus site) 41 CitationsAbstract
STUDY OBJECTIVES: Changes in lymphocyte phenotype and functionality have been described in adult patients with obstructive sleep apnea (OSA). We hypothesized that OSA is associated with T lymphocyte alterations in children, particularly in T regulatory lymphocytes (T regs), and aimed to characterize circulating T lymphocyte subsets in children with OSA.
DESIGN: Cross-sectional.
SETTING: Kosair Children's Hospital (Louisville, KY, USA) and Comer Children's Hospital (Chicago, IL, USA).
PARTICIPANTS: Consecutively recruited children being evaluated for habitual snoring.
INTERVENTIONS: N/A.
MEASUREMENTS AND RESULTS: Overnight polysomnography (PSG) was performed and a fasting blood sample was obtained from the patients. Flow cytometry was performed on peripheral blood mononuclear cells stained for CD3, CD4, CD8, CD25, FOXP3, interleukin-4 (IL-4), interferon-γ (IFN-γ), and IL-17. Patients were divided into three groups based on their PSG: controls (apnea-hypopnea indices [AHI] < 1/h total sleep time [TST]), mild OSA (1 ≤ AHI < 5/hTST), moderate-severe OSA (AHI ≥ 5/h TST). The percentage of CD4+ and T reg lymphocytes differed across groups. Children with moderate-severe OSA had significantly reduced T reg than control children (median [interquartile range] 4.8 [3.8-5.7% CD4+] versus 7.8 [7.0-9.2% CD4+]; P < 0.001). There were also significant differences in the percentage of T helper 1 (Th1) lymphocytes and in Th1:Th2 ratios between groups. Children with moderate-severe OSA had increased Th1 cells (P = 0.001) and Th1:Th2 ratios (P = 0.0026) compared with children with mild OSA and control children. Associations between AHI and T reg (P = 0.0003; r = -0.46), CD4+ lymphocytes (P = 0.0047; r = -0.37), and Th1:Th2 ratios (P = 0.0009; r = 0.43) emerged. In addition, the percentage of T reg was inversely correlated with Th1:Th2 ratios (P = 0.029; r = -0.29).
CONCLUSIONS: Pediatric OSA is associated with reduced T reg population and altered Th1:Th2 balance toward Th1 predominance, suggesting a shift to a proinflammatory state. The changes in lymphocytic phenotypes associated with OSA may contribute to the variance in systemic inflammation and downstream morbidities associated with this condition.
Author List
Tan HL, Gozal D, Wang Y, Bandla HP, Bhattacharjee R, Kulkarni R, Kheirandish-Gozal LAuthor
Hari Bandla MD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
ChildChild, Preschool
Cross-Sectional Studies
Female
Flow Cytometry
Humans
Lymphocyte Count
Male
Polysomnography
Sleep Apnea, Obstructive
T-Lymphocyte Subsets