Serum Leukotriene B4 Levels, Tonsillar Hypertrophy and Sleep-Disordered Breathing in Childhood

Publication date: Available online 7 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Emmanouel Ι. Alexopoulos, George Haritos, Christina Befani, Georgia Malakasioti, Vassilis A. Lachanas, Panagiotis Liakos, Konstantinos Gourgoulianis, Athanasios G. Kaditis

Abstract

Objectives

In children with snoring, increased production of leukotriene B₄ (LTB₄) may promote tonsillar hypertrophy and sleep-disordered breathing (SDB) or conversely SDB may enhance LTB₄ synthesis. We explored whether: i) high LTB₄ serum levels predict tonsillar hypertrophy; and ii) SDB severity correlates with LTB₄ serum concentration.

Methods

Normal-weight children with SDB or controls underwent polysomnography and measurement of LTB₄ serum concentration. Tonsillar hypertrophy was the main outcome measure and high LTB₄ serum level (>75 t h percentile value in controls) was the primary explanatory variable. Odds ratio (OR) and the corresponding 95% confidence intervals (CI) for tonsillar hypertrophy in children with versus without high LTB₄ level were calculated. The control subgroup and subgroups of subjects with increasing SDB severity were compared regarding LTB₄ concentration by Kruskal-Wallis test. Spearman's correlation co-efficient was applied to assess the association of LTB₄ concentration with SDB severity.

Results

A total of 104 children with SDB and mean obstructive apnea-hypopnea index-AHI of 4.8 ± 5.3 episodes/h (primary snoring: n=19; mild SDB: n=49; moderate/severe SDB: n=36) and 13 controls (no snoring; AHI: 0.4 ± 0.2 episodes/h) were recruited. The four study subgroups were similar regarding LTB₄ serum concentration (P=0.64). High LTB₄ (>170.3 pg/mL) was a significant predictor of tonsillar hypertrophy after adjustment for age and gender (OR 3.0 [1.2-7.2]; P=0.01). There was no association between AHI or desaturation index and LTB₄ serum concentration (r=-0.08; P=0.37 and r=-0.1; P=0.30, respectively).

Conclusion

No association was identified between SDB severity and LTB₄ levels, but high LTB₄ concentration predicted tonsillar hypertrophy.

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