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Inflammatory Mediators in Exhaled Breath Condensate of Children With Obstructive Sleep Apnea Syndrome^*

^* From Kosair Children’s Hospital Research Institute (Drs. Goldbart, Li, and Serpero), Department of Pediatrics (Dr. Krishna), Division of Sleep Medicine, and Department of Pharmacology and Toxicology (Dr. Gozal), University of Louisville, Louisville, KY.

Correspondence to: David Gozal, MD, FCCP; Kosair Children’s Hospital Research Institute, University of Louisville, 570 South Preston St, Suite 321, Louisville, KY 40202; e-mail: david.gozal{at}louisville.edu

Abstract

Background: Upper airway inflammation is now recognized in adults with obstructive sleep apnea (OSA) syndrome. However, the role played by eicosanoids such as leukotrienes and prostaglandins is unclear.

Objective: To investigate whether eicosanoids are measurable in exhaled breath condensate (EBC), and to determine whether differences in these inflammatory mediators emerge among children with and without sleep-disordered breathing (SDB).

Methods: EBC was collected from 50 consecutive snoring children undergoing overnight polysomnography for suspected SDB, and from 12 nonsnoring control subjects. Prostaglandin E₂ (PGE₂), leukotriene B₄ (LTB₄), and cysteinyl leukotrienes (cys-LTs: leukotriene C₄ [LTC₄]/leukotriene D₄ [LTD₄]/leukotriene E₄ [LTE₄]) EBC levels were analyzed using enzyme-linked immunosorbent assay.

Results: LTB₄ levels were elevated in children with an apnea-hypopnea index (AHI) > 5/h (SDB; 97.6 ± 6.3 pg/mL) compared to children with an AHI < 5/h (mild SDB; 66.4 ± 19.1 pg/mL; p < 0.01) and control subjects (27.8 ± 3.7 pg/mL; p < 0.01). Similarly, cys-LT (LTC₄/LTD₄/LTE₄) concentrations were also increased in SDB (45.1 ± 10.6 pg/mL in SDB vs 27.6 ± 8.3 pg/mL in mild SDB, and 15.7 ± 7.6 pg/mL in control subjects; p < 0.01). In contrast, PGE₂ concentrations were similar among the three groups.

Conclusions: Inflammatory mediators such as leukotrienes and prostaglandins can be readily quantified in EBC collected from the upper airway of children. Disease severity-dependent increases in leukotriene concentrations (LTB₄ and LTC₄/LTD₄/LTE₄) emerge among children and may serve as a noninvasive tool in the clinical assessment of these children.

Key Words: adenoids • eicosanoids • inflammation • leukotrienes • lymphoid hyperplasia • sleep apnea • sleep-disordered breathing • tonsillectomy and adenoidectomy • tonsils

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