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Maric, J., Ravindran, A., Mazzurana, L., Van Acker, A., Rao, A., Kokkinou, E., . . . Mjosberg, J. (2019). Cytokine-induced endogenous production of prostaglandin D-2 is essential for human group 2 innate lymphoid cell activation. Journal of Allergy and Clinical Immunology, 143(6), 2202-2214.e5
Open this publication in new window or tab >>Cytokine-induced endogenous production of prostaglandin D-2 is essential for human group 2 innate lymphoid cell activation
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2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 143, no 6, p. 2202-2214.e5Article in journal (Refereed) Published
Abstract [en]

Objective: We set out to examine PG production in human ILC2s and the implications of such endogenous production on ILC2 function. Methods: The effects of the COX-1/2 inhibitor flurbiprofen, the hematopoietic prostaglandin D2 synthase (HPGDS) inhibitor KMN698, and the CRTH2 antagonist CAY10471 on human ILC2s were determined by assessing receptor and transcription factor expression, cytokine production, and gene expression with flow cytometry, ELISA, and quantitative RT-PCR, respectively. Concentrations of lipid mediators were measured by using liquid chromatography-tandem mass spectrometry and ELISA. Results: We show that ILC2s constitutively express HPGDS and upregulate COX-2 upon IL-2, IL-25, and IL-33 plus thymic stromal lymphopoietin stimulation. Consequently, PGD2 and its metabolites can be detected in ILC2 supernatants. We reveal that endogenously produced PGD2 is essential in cytokine-induced ILC2 activation because blocking of the COX-1/2 or HPGDS enzymes or the CRTH2 receptor abolishes ILC2 responses. Conclusion: PGD2 produced by ILC2s is, in a paracrine/autocrine manner, essential in cytokine-induced ILC2 activation. Hence we provide the detailed mechanism behind how CRTH2 antagonists represent promising therapeutic tools for allergic diseases by controlling ILC2 function.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2019
Keywords
Group 2 innate lymphoid cells, prostaglandin D-2, chemoattractant receptor-homologous molecule expressed on T(H)2 cells, allergy
National Category
Immunology Immunology in the medical area Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-387922 (URN)10.1016/j.jaci.2018.10.069 (DOI)000470113200024 ()30578872 (PubMedID)
Funder
Swedish Research Council, 521-2013-2791Swedish Foundation for Strategic Research , ICA120023Swedish Research CouncilSwedish Foundation for Strategic Research Swedish Cancer Society, 130396Swedish Society for Medical Research (SSMF)German Research Foundation (DFG)Swedish Heart Lung Foundation, HLF 20150640; HLF 20140469
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
Vangeti, S., Gertow, J., Yu, M., Liu, S., Baharom, F., Scholz, S., . . . Smed-Sörensen, A. (2019). Human Blood and Tonsil Plasmacytoid Dendritic Cells Display Similar Gene Expression Profiles but Exhibit Differential Type I IFN Responses to Influenza A Virus Infection. Journal of Immunology, 202(7), 2069-2081
Open this publication in new window or tab >>Human Blood and Tonsil Plasmacytoid Dendritic Cells Display Similar Gene Expression Profiles but Exhibit Differential Type I IFN Responses to Influenza A Virus Infection
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2019 (English)In: Journal of Immunology, ISSN 0022-1767, E-ISSN 1550-6606, Vol. 202, no 7, p. 2069-2081Article in journal (Refereed) Published
Abstract [en]

Influenza A virus (IAV) infection constitutes an annual health burden across the globe. Plasmacytoid dendritic cells (PDCs) are central in antiviral defense because of their superior capacity to produce type I IFNs in response to viruses. Dendritic cells (DCs) differ depending on their anatomical location. However, only limited host-pathogen data are available from the initial site of infection in humans. In this study, we investigated how human tonsil PDCs, likely exposed to virus because of their location, responded to IAV infection compared with peripheral blood PDCs. In tonsils, unlike in blood, PDCs are the most frequent DC subset. Both tonsil and blood PDCs expressed several genes necessary for pathogen recognition and immune response, generally in a similar pattern. MxA, a protein that renders cells resistant to IAV infection, was detected in both tonsil and blood PDCs. However, despite steady-state MxA expression and contrary to previous reports, at high IAV concentrations (typically cytopathic to other immune cells), both tonsil and blood PDCs supported IAV infection. IAV exposure resulted in PDC maturation by upregulation of CD86 expression and IFN-alpha secretion. Interestingly, blood PDCs secreted 10-fold more IFN-alpha in response to IAV compared with tonsil PDCs. Tonsil PDCs also had a dampened cytokine response to purified TLR ligands compared with blood PDCs. Our findings suggest that tonsil PDCs may be less responsive to IAV than blood PDCs, highlighting the importance of studying immune cells at their proposed site of function.

Place, publisher, year, edition, pages
AMER ASSOC IMMUNOLOGISTS, 2019
National Category
Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-381117 (URN)10.4049/jimmunol.1801191 (DOI)000461705000017 ()30760619 (PubMedID)
Funder
Swedish Research CouncilSwedish Heart Lung FoundationSwedish Childhood Cancer FoundationThe Karolinska Institutet's Research Foundation
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-04-05Bibliographically approved
Fehrm, J., Nerfeldt, P., Sundman, J. & Friberg, D. (2018). Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea A Randomized Clinical Trial. JAMA Otolaryngology - Head and Neck Surgery, 144(7), 580-586
Open this publication in new window or tab >>Adenopharyngoplasty vs Adenotonsillectomy in Children With Severe Obstructive Sleep Apnea A Randomized Clinical Trial
2018 (English)In: JAMA Otolaryngology - Head and Neck Surgery, ISSN 2168-6181, E-ISSN 2168-619X, Vol. 144, no 7, p. 580-586Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Adenotonsillectomy (ATE) is the primary surgical method for treating obstructive sleep apnea (OSA) in children. However, children with severe OSA have an increased risk for residual OSA after ATE. Previous studies indicate that adenopharyngoplasty (APP), a modified ATE with closure of the tonsillar pillars, might improve the surgical outcome, but the overall evidence is weak. OBJECTIVE To determine whether APP is more effective than ATE for treating severe OSA in otherwise healthy children. DESIGN, SETTING. AND PARTICIPANTS A blinded randomized clinical trial was conducted at the otorhinolaryngology department at Karolinska University Hospital, Stockholm, Sweden. Eighty-three children, aged 2 to 4 years, with an obstructive apnea-hypopnea index (OAHI) score of 10 or higher, were randomized to APP (n = 36) or ATE (n = 47). Participants were recruited from December 1, 2014, through November 31, 2016. INTERVENTIONS Adenotonsillectomy was performed in all 83 patients in both groups by the cold steel technique. The APP group also underwent closure of the tonsillar pillars with 2 inverted sutures on each side. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the groups in OAHI score change before and after surgery. A higher score indicates worse problems and a score of 10 or higher is defined as severe OSA. The outcome was evaluated per protocol and with intention-to-treat analysis. Secondary outcomes were other polysomnography variables and the Obstructive Sleep Apnea-18 (OSA-18) questionnaire (possible total symptom score range, 18-126; higher scores indicate worse quality of life). Polysomnography was performed and the OSA-18 questionnaire was completed preoperatively and 6 months postoperatively. RESULTS A total of 83 children (49 [59%] boys; mean [SD] age, 36.6 [9.2] months) were included in the study. Of these, 74(89%) (APP, n = 30; ATE, n = 44) completed the study. The mean (SD) preoperative OAHI score was 23.8 (11.8) for APP and 23.8 (11.5) for ATE. Both the APP and ATE groups had a significant decrease in mean OAHI score after surgery (-21.7; 95% CI, -26.3 to -17.2; and -21.1; 95% CI, -24.5 to -17.7, respectively), but there was no significant difference between the groups (0.7; 95% CI, -4.8 to 6.1). Furthermore, no significant differences between the groups were seen regarding other polysomnography variables (eg, respiratory distress index: mean, 0.6; 95% CI, -5.0 to 6.3) or the OSA-18 questionnaire (eg, total symptom score: -0.5; 95% CI, -13 to12). One patient from each group was readmitted owing to postoperative bleeding, but no other complications were seen. CONCLUSIONS AND RELEVANCE This trial did not show that APP was more effective than ATE alone to treat otherwise healthy children with severe OSA. This finding suggests that ATE should continue to be the primary treatment for OSA in children.

Place, publisher, year, edition, pages
AMER MEDICAL ASSOC, 2018
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-362170 (URN)10.1001/jamaoto.2018.0487 (DOI)000439291000008 ()29852045 (PubMedID)
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2018-10-30
Sundman, J., Fehrm, J. & Friberg, D. (2018). Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection. European Archives of Oto-Rhino-Laryngology, 275(6), 1541-1545
Open this publication in new window or tab >>Low inter-examiner agreement of the Friedman staging system indicating limited value in patient selection
2018 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 275, no 6, p. 1541-1545Article in journal (Refereed) Published
Abstract [en]

The Friedman staging system is a clinical method for selecting patients with obstructive sleep apnoea who are likely to benefit from uvulopalatopharyngoplasty. The objective of this study was to evaluate the system by determining its inter-examiner agreement. Twelve patients with obstructive sleep apnoea were examined by 14 doctors. The Friedman stage was derived from tonsil size and tongue position, and a Cohen's kappa analysis was performed to assess inter-examiner agreement. One hundred and sixty-eight ratings were performed. The median kappa for tongue position was 0.32 (first and third quartiles: 0.21 and 0.44) and was 0.62 (0.50 and 0.63) for tonsil size. The median kappa for the Friedman stage was 0.38 (0.24 and 0.55), which corresponds to only a slight or fair agreement. The Friedman staging system demonstrated a low inter-examiner agreement, indicating that the system is an uncertain method for selecting patients for uvulopalatopharyngoplasty. Level of evidence: 2B.

Keywords
Inter-examiner agreement, Friedman tongue position, Uvulopalatopharyngoplasty, Obstructive sleep apnoea
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-356853 (URN)10.1007/s00405-018-4970-z (DOI)000432207000021 ()29663113 (PubMedID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-16Bibliographically approved
Maric, J., Ravindran, A., Mazzurana, L., Björklund, Å. K., Van Acker, A., Rao, A., . . . Mjösberg, J. (2018). Prostaglandin E-2 suppresses human group 2 innate lymphoid cell function. Journal of Allergy and Clinical Immunology, 141(5), 1761-1773.e6
Open this publication in new window or tab >>Prostaglandin E-2 suppresses human group 2 innate lymphoid cell function
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2018 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 141, no 5, p. 1761-1773.e6Article in journal (Refereed) Published
Abstract [en]

Background: Group 2 innate lymphoid cells (ILC2s) are involved in the initial phase of type 2 inflammation and can amplify allergic immune responses by orchestrating other type 2 immune cells. Prostaglandin (PG) E-2 is a bioactive lipid that plays protective roles in the lung, particularly during allergic inflammation.

Objective: We set out to investigate how PGE(2) regulates human ILC2 function.

Methods: The effects of PGE(2) on human ILC2 proliferation and intracellular cytokine and transcription factor expression were assessed by means of flow cytometry. Cytokine production was measured by using ELISA, and real-time quantitative PCR was performed to detect PGE(2) receptor expression.

Results: PGE(2) inhibited GATA-3 expression, as well as production of the type 2 cytokines IL-5 and IL-13, from human tonsillar and blood ILC2s in response to stimulation with a combination of IL-25, IL-33, thymic stromal lymphopoietin, and IL-2. Furthermore, PGE(2) downregulated the expression of IL-2 receptor alpha (CD25). In line with this observation, PGE(2) decreased ILC2 proliferation. These effects were mediated by the combined action of E-type prostanoid receptor (EP) 2 and EP4 receptors, which were specifically expressed on ILC2s.

Conclusion: Our findings reveal that PGE(2) limits ILC2 activation and propose that selective EP2 and EP4 receptor agonists might serve as a promising therapeutic approach in treating allergic diseases by suppressing ILC2 function.

Place, publisher, year, edition, pages
MOSBY-ELSEVIER, 2018
Keywords
ILC2, allergy, prostaglandin E-2, E-type prostanoid receptor 2, E-type prostanoid receptor 4
National Category
Immunology Immunology in the medical area
Identifiers
urn:nbn:se:uu:diva-356458 (URN)10.1016/j.jaci.2017.09.050 (DOI)000432148200023 ()29217133 (PubMedID)
Funder
Swedish Research Council, 521-2013-2791Swedish Foundation for Strategic Research , ICA12-0023Swedish Cancer Society, 130396Swedish Society for Medical Research (SSMF)
Available from: 2018-07-31 Created: 2018-07-31 Last updated: 2018-10-30Bibliographically approved
N, B., J, B. & Friberg, D. (2018). SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP.. The Laryngoscope
Open this publication in new window or tab >>SKUP3: 6 and 24 months follow-up of changes in respiration and sleepiness after modified UPPP.
2018 (English)In: The LaryngoscopeArticle in journal (Refereed) Published
Abstract [en]

Objective

Our previous randomized controlled trial of patients with obstructive sleep apnea syndrome (OSAS) showed that modified uvulopalatopharyngoplasty (UPPP), including tonsillectomy, significantly improved nocturnal respiration, daytime sleepiness, and quality of life in the intervention group compared to controls who had delayed surgery after 6 months. This is the continuous report with the 6‐ and 24‐month postoperative results.

Study Design

Single‐center prospective cohort study.

Methods

Sixty‐five patients with apnea–hypopnea index (AHI) ≥ 15, body mass index (BMI) < 36, Epworth Sleepiness Scale (ESS) ≥ 8, and Friedman stage I or II underwent UPPP after failing nonsurgical treatment. The results from polysomnography and ESS at 6 and 24 months were compared to baseline.

Results

Eight percent and 20% dropped out from the 6‐ and 24‐month follow‐ups, respectively. The AHI value decreased significantly from mean (standard deviation) 52.9 (20.5) at baseline to 23.6 (20.2) after 6 months, and to 24.1 (20.9) after 24 months (P < 0.001). Patients with tonsil size 2, and 3 to 4, had significant reductions in the AHI after both follow‐ups. The median ESS score decreased significantly from 13 (range 8–21) to 6.5 (1–18) after 6 months, and to 5 (2–17) after 24 months (P < 0.001). The BMI remained unchanged. There were significant modest correlations for the reductions in AHI and ESS after 24 months.

Conclusion

Modified UPPP was effective in improving nocturnal respiration and daytime sleepiness in OSAS patients at both 6‐ and 24‐month follow‐up. Patients with tonsil size 2, and 3 to 4, benefitted similarly from surgery with improved respiration.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-364581 (URN)10.1002/lary.26835 (DOI)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-14Bibliographically approved
E, P., I, B.-L. & Friberg, D. (2018). Sleep patterns among patients with chronic fatigue: A polysomnography-based study.. The clinical respiratory journal, 12(4)
Open this publication in new window or tab >>Sleep patterns among patients with chronic fatigue: A polysomnography-based study.
2018 (English)In: The clinical respiratory journal, Vol. 12, no 4Article in journal (Refereed) Published
Abstract [en]

Objectives

The purpose of this study was to detect treatable sleep disorders among patients complaining of chronic fatigue by using sleep questionnaires and polysomnography.

Methods

Patients were referred to hospital for investigations and rehabilitation because of a suspected diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The criteria for further referral to full‐night polysomnography (PSG) were symptoms of excessive daytime sleepiness and/or tiredness in the questionnaires.

Results

Of a total of 381 patients, 78 (20.5%) patients underwent PSG: 66 women and 12 men, mean age 48.6 years, standard deviation ±9.9 years. On the basis of the PSG, 31 (40.3%) patients were diagnosed with obstructive sleep apnoea, 7 (8.9%) patients with periodic limb movement disorder, 32 (41.0%) patients with restless legs syndrome and 54 (69.3%) patients had one or more other sleep disorder. All patients were grouped into those who fulfilled the diagnostic criteria for ME/CFS (n = 55, 70.5%) and those who did not (n = 23, 29.5%). The latter group had significantly higher respiratory (P = .01) and total arousal (P = .009) indexes and a higher oxygen desaturation index (P = .009).

Conclusions

More than half of these chronic fatigue patients, who also have excessive daytime sleepiness and/or tiredness, were diagnosed with sleep disorders such as obstructive sleep apnoea, periodic limb movement disorder and/or restless legs syndrome. Patients with such complaints should undergo polysomnography, fill in questionnaires and be offered treatment for sleep disorders before the diagnose ME/CFS is set.

Place, publisher, year, edition, pages
Wiley Online Library, 2018
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-364582 (URN)10.1111/crj.12667 (DOI)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-14Bibliographically approved
Sundman, J., Friberg, D., Bring, J., Lowden, A., Nagai, R. & Browaldh, N. (2018). Sleep Quality After Modified Uvulopalatopharyngoplasty: Results From the SKUP3 Randomized Controlled Trial. Sleep, 41(1), Article ID zsx180.
Open this publication in new window or tab >>Sleep Quality After Modified Uvulopalatopharyngoplasty: Results From the SKUP3 Randomized Controlled Trial
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2018 (English)In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 41, no 1, article id zsx180Article in journal (Refereed) Published
Abstract [en]

Study Objectives: To investigate whether uvulopalatopharyngoplasty (UPPP) improves sleep quality in patients with obstructive sleep apnea (OSA) using the Functional Outcomes of Sleep Questionnaire (FOSQ) and the Karolinska Sleep Questionnaire (KSQ).

Methods: Randomized controlled trial used to compare modified UPPP with controls at baseline and after 6 months. The controls received delayed surgery and a 6-month postoperative follow-up. All operated patients were offered a 24-month follow-up. At each follow-up, patients underwent polysomnography and vigilance testing and completed questionnaires. Nine scales were evaluated: five subscales and the total score in the FOSQ and three subscales in the KSQ.

Results: Sixty-five patients, mean 42.3 years (SD 11.5), Friedman stage I and II, body mass index < 36 kg/m(2), and moderate-to-severe OSA, were randomized to intervention (n = 32) or control (n = 33). In the FOSQ and in the KSQ, the mean rate of missing values was 6.2% (range 0%-19%) and 20.5% (3%-38%), respectively. In 8 of 9 scales, significant differences were observed between the groups in favor of UPPP. There were significant correlations between results from the questionnaires and objective measures from polysomnography and the vigilance test. At the 6- and 24-month postoperative follow-ups, eight of nine scales were significantly improved compared with baseline.

Conclusions: In selected patients with OSA, subjective sleep quality was significantly improved 6 months after UPPP compared with controls, with stable improvements 24 months postoperatively. The correlations between subjective and objective outcomes and the long-term stability suggest a beneficial effect from surgery, although a placebo effect cannot be excluded.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS INC, 2018
Keywords
subjective outcome, sleep quality, surgical treatment, apnea, randomized controlled
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-342461 (URN)10.1093/sleep/zsx180 (DOI)000422879100003 ()
Funder
Stockholm County Council
Available from: 2018-02-26 Created: 2018-02-26 Last updated: 2018-10-30
V, K., P, C., M, F., A, R., E, K., EJ, V., . . . J, M. (2018). Vitamin D downregulates the IL-23 receptor pathway in human mucosal group 3 innate lymphoid cells.. Journal of Allergy and Clinical Immunology, 141(1), 279-292
Open this publication in new window or tab >>Vitamin D downregulates the IL-23 receptor pathway in human mucosal group 3 innate lymphoid cells.
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2018 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 141, no 1, p. 279-292Article in journal (Refereed) Published
Abstract [en]

Background

Vitamin D deficiency is a risk factor for inflammatory bowel disease (IBD). The IL-23–driven tissue-resident group 3 innate lymphoid cells (ILC3s) play essential roles in intestinal immunity, and targeting IL-23/12 is a promising approach in IBD therapy.

Objective

We set out to define the role of 1α,25-dihydroxy vitamin D3 (1,25D) in regulating functional responses of human mucosal ILC3s to IL-23 plus IL-1β stimulation.

Methods

Transcriptomes of sorted tonsillar ILC3s were assessed by using microarray analysis. ILC3 cytokine production, proliferation, and differentiation were determined by means of flow cytometry, ELISA, and multiplex immunoassay. Intestinal cell suspensions and ILC3s sorted from gut biopsy specimens of patients with IBD were also analyzed along with plasma 25-hydroxy vitamin D3 (25D) detection.

Results

ILC3s stimulated with IL-23 plus IL-1β upregulated the vitamin D receptor and responded to 1,25D with downregulation of the IL-23 receptor pathway. Consequently, 1,25D suppressed IL-22, IL-17F, and GM-CSF production from tonsillar and gut ILC3s. In parallel, 1,25D upregulated genes linked to the IL-1β signaling pathway, as well as the IL-1β–inducible cytokines IL-6, IL-8, and macrophage inflammatory protein 1α/β. The 1,25D-triggered skewing in ILC3 function was not accompanied or caused by changes in viability, proliferation, or phenotype. Finally, we confirmed low 25D plasma levels in patients with IBD with active inflammation.

Conclusion

In light of the beneficial targeting of IL-23/12 in patients with IBD, 1,25D appears as an interesting therapeutic agent that inhibits the IL-23 receptor pathway, providing a novel mechanism for how ILC3s could be manipulated to regulate intestinal inflammation.

Place, publisher, year, edition, pages
ScienceDirect, 2018
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-364584 (URN)10.1016/j.jaci.2017.01.045 (DOI)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-20Bibliographically approved
Borgström, A., Nerfeldt, P. & Friberg, D. (2017). Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT.. Pediatrics, 139(7)
Open this publication in new window or tab >>Adenotonsillotomy Versus Adenotonsillectomy in Pediatric Obstructive Sleep Apnea: An RCT.
2017 (English)In: Pediatrics, Vol. 139, no 7Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adenotonsillectomy (ATE) is a well-established and effective treatment of pediatric obstructive sleep apnea (OSA). In recent years, a more conservative method, adenotonsillotomy (ATT), has gained popularity because it is associated with less postoperative morbidity. Yet no previous randomized study has compared these 2 methods regarding their effectiveness in treating pediatric OSA in terms of polysomnographic data, which was the primary aim of this study. The hypothesis was that ATT is noninferior to ATE after 1 year.

METHODS: Seventy-nine children, aged 2 to 6 years, with OSA (Apnea-Hypopnea Index [AHI] 5–30) were randomized to ATT (n = 40) or ATE (n = 39). Polysomnography (PSG) and questionnaire OSA-18 were assessed at baseline and 1 year postsurgery.

RESULTS: Mean difference between groups in the primary outcome, change in AHI, was 0.83, 95% confidence interval –3.2 to 4.9, not exceeding the noninferiority margin of 5. After ATE, AHI decreased from median 12.7 (interquartile range 8.3–19.1) to 2.0 (1.2–3.1) and after ATT from 15.8 (8.5–21.2) to 4.0 (1.2–5.1). For both groups, significant improvements of PSG and OSA-18 questionnaire outcomes were observed, with no significant differences between groups. Five children (13%) in the ATT group needed repeated surgery for tonsil regrowth and recurrence of OSA.

CONCLUSIONS: The results suggest that ATT is noninferior to ATE in treating pediatric OSA regarding PSG outcomes after 1 year. ATT could be considered an alternative to ATE for treatment of pediatric OSA. However, after ATT, there is a nonnegligible risk of recurrence of OSA, and this should be taken into account when selecting surgical method.

National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-364588 (URN)10.1542/peds.2016-3314 (DOI)
Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-02-21Bibliographically approved
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