(185) Evaluating Inflammatory Markers as a Predictor of Adenotonsillectomy (T&A) Success

Introduction: Systemic inflammatory biomarkers such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-a) are known to be elevated in pediatric patients with obstructive sleep apnea (OSA) and obesity. This study aimed to evaluate the value of such inflammatory markers of predicting clinical outcomes after adenotonsillectomy (AT) in pediatric patients with OSA; a secondary aim was to determine the economic impact of utilizing these markers.

Methods: We conducted a prospective case series from August 2018 to October 2019 enrolling pediatric patients with OSA undergoing AT at a tertiary academic medical center. Patient demographics, polysomnogram (PSG) data, and CRP and TNF-a levels were collected preoperatively. Outcomes of interest included postoperative PSG data of lowest arterial oxygen saturation (SaO2), total apnea hypopnea index (AHI), and obstructive apnea hypopnea index (OAHI). A Spearman’s rank correlation was conducted between each inflammatory marker and outcome.

Results: Twenty patients with a median age (IQR) of 9.5 years (7.0-11.5) and BMI >95th percentile were enrolled. Baseline PSG data included median SaO2 nadir (IQR) of 85 (75-91), median total apnea hypopnea index (AHI) (IQR) of 10 (5-24), and median obstructive AHI (IQR) of 9.4 (4.3-23.0). Eight patients completed a postoperative PSG. Preoperative CRP was not correlated with SaO2 (r=0.12, p=0.786), AHI (r=-0.26, p=0.528), or OAHI (r= -0.26, p=0.528). Preoperative TNF-a was not correlated with SaO2 (r=-0.15, p=0.749), AHI (r=0.19, p=0.691), or OAHI (r=0.56, p=0.195). The institutional cost of labs was approximately $87.40 per patient.

Conclusions: While a cheaper option than postoperative PSGs, inflammatory biomarkers were not correlated with clinical measurements postoperatively in this study. Future investigations could correlate these markers with other signs of clinical improvement with OSA post-AT.