Sleep measures and morning plasma TNF-α levels in children with sleep-disordered breathing

Background: Sleep disordered breathing in children is associated with severity-dependent increases in excessive daytime sleepiness (EDS). TNF-α is an inflammatory cytokine that has been implicated in EDS. Since, at any given level of apnea-hypopnea index, there is significant variability in EDS, we hypothesized that morning tumor necrosis factor (TNF)-α plasma levels may provide a biologic correlate of EDS. Methods: Children being evaluated for sleep disordered breathing underwent a blood draw after nocturnal polysomnography, and TNF-α plasma concentrations were assayed using ELISA. In a subset of 15 children with sleep disordered breathing and in 15 matched control subjects, whole blood cultures in the presence of lipopolysaccharide and Multiple Sleep Latency Test were conducted. Furthermore, 22 children with obstructive sleep apnea had TNF-α levels assayed and underwent nocturnal polysomnography and Multiple Sleep Latency Test before and after adenotonsil- adenotonsillectomy. Results: In 298 children, morning TNF-α levels were globally increased in the presence of obstructive sleep apnea, particularly in more severe cases, and correlated with obstructive apnea-hypopnea index and sleep pressure score, a measure of respiratory-induced sleep fragmentation, but not with nadir SaO ₂. A stepwise logistic regression analysis revealed that sleep pressure score and body mass index accounted for 36.2% of the adjusted variance in TNF-α levels (P < 0.0001). Furthermore, multiple sleep latencies were correlated with whole blood culture-derived TNF-α levels (n = 15), and morning TNF-α levels decreased after adenotonsillectomy in 22 children. Conclusions: TNF-α levels are increased in pediatric obstructive sleep apnea, are primarily driven by sleep fragmentation and body mass index, and are closely associated with the degree of sleepiness, as measured by Multiple Sleep Latency Test. Furthermore, surgical treatment of obstruc- . obstructive sleep apnea results in significant reductions in TNF-α levels with reciprocal prolongations in sleep latency.