This study comprises 57 patients, 29 of which were treated by anterior palatoplasty procedure, expansion sphincter pharyngoplasty and submucosal minimal invasive lingual excision techniques and 27 by CPAP therapy. Parameters to determine success were AHI, VAS score, ESS score, mean Sa02, SaO2 < 90%, oxygen de-saturation index and minimum Sa02. To compare the pre-treatment and post-treatment inflammatory / anti-inflammatory balance, serum levels of mediators and inhibitors of inflammation were studied and incorporated with the above mentioned OSAS parameters. It was observed that the pro-inflammatory cytokines, namely Interleukin 2, gamma-interferon and tumour necrosis factor (TNF-alpha) showed a downward shift compared with anti-inflammatory cytokines, namely IL4, IL10 and the ratios of the former to the latter decreased. This was more noticeable in the surgical treatment group, particularly a reduction in gamma-interferon level, whereas improvement in the subjective parameters was more noticeable in the CPAP treatment group. More obese patients showed a greater reduction in the TNF-alpha levels after treatment. The authors contend that successful treatment of OSAS promotes TH2 activity, thus suppressing TH1 mediated inflammation and shifts the balance against it. This is an elaborately structured study but further work is required to establish more direct correlation between cytokine levels and clinical improvement in the management of OSAS.

Effect of modern surgical treatment on the inflammatory/anti-inflammatory balance in patients with obstructive sleep apnoea.
Binar M, Akcam TM, Karakoc O, Sagkan RI, Musabak U, Gerek M.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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