(1) Lee YC, Lu CT, Chuang LP, Lee LA, Fang TJ, Cheng WN, Li HY. Pharmacotherapy for obstructive sleep apnea - A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2023 Aug;70:101809.
(2) Chuang HH, Lin RH, Hsu JF, Chuang LP, Li HY, Fang TJ, Huang YS, Yang AC, Lee GS, Kuo TBJ, Yang CCH, Lee LA (Corresponding author). Dietary profile of pediatric obstructive sleep apnea patients, effects of routine educational counseling, and predictors for outcomes. Front Public Health. 2023 Jun 12;11:1160647.
(3) Huang CG, Hsu JF, Chuang LP, Li HY, Fang TJ, Huang YS, Yang AC, Lee GS, Kuo TBJ, Yang CCH, Lee LA (Corresponding author), Chuang HH. Adenotonsillectomy-related changes in systemic inflammation among children with obstructive sleep apnea. J Chin Med Assoc. 2023 Jun 1;86(6):596-605.
(4) Hsieh HS, Chuang HH, Hsin LJ, Lin WN, Kang CJ, Zhuo MY, Chuang LP, Huang YS, Li HY, Fang TJ, Lee LA (Corresponding author). Effect of Preoperative Weight Status and Disease Presentation on Postoperative Elevated Blood Pressure After Childhood Adenotonsillectomy. Otolaryngol Head Neck Surg. 2023 May;168(5):1197-1208.
(5) Lee LA, Chuang HH, Hsieh HS, Wang CY, Chuang LP, Li HY, Fang TJ, Huang YS, Lee GS, Yang AC, Kuo TBJ, Yang CCH. Using sleep heart rate variability to investigate the sleep quality in children with obstructive sleep apnea. Front Public Health. 2023 Feb 27;11:1103085.
(6) Chen TY, Kung YY, Lai HC, Lee LA, Jen IA, Chang HA, Liu CY, Kuo TBJ, Yang CCH. Prevalence and effects of sleep-disordered breathing on middle-aged patients with sedative-free generalized anxiety disorder: A prospective case-control study. Front Psychiatry. 2023 Jan 9;13:1067437.
(7) Lin CC, Liu KH, Lee LA, Chuang LP, Lin YS, Hsin LJ, Lin WN, Chiang YT, Cheng WN, Li HY. Combined Airway and Bariatric Surgery (CABS) for Obstructive Sleep Apnea Patients with Morbid Obesity: A Comprehensive Alternative Preliminary Study. J Clin Med. 2022 Nov 29;11(23):7078.
(8) Li HY, Tsai MS, Lee LA, Hsin LJ, Lee YC, Lin WN, Lu YA, Shen SC, Cheng WN, Chaing YT. Palatal hybrid surgery for obstructive sleep apnea-state-of-the-art annotation of uvulopalatopharyngoplasty. Biomed J. 2022 Nov 8;46(3):100568.
(9) Lu CT, Lee LA, Lee GS, Li HY. Obstructive Sleep Apnea and Auditory Dysfunction-Does Snoring Sound Play a Role? Diagnostics (Basel). 2022 Sep 30;12(10):2374.
(10) Hsin LJ, Lee YC, Lin WN, Lu YA, Lee LA, Tsai MS, Cheng WN, Chiang YT, Li HY. Transoral Tongue Suspension for Obstructive Sleep Apnea-A Preliminary Study. J Clin Med. 2022 Aug 24;11(17):4960.
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Introduction: Childhood sleep apnea syndrome is associated with a wide range of adverse health outcomes, including poor sleep quality, autonomic dysfunction, systemic inflammation, gut dysbiosis, and unhealthy food literacy. In this study, our objective was to explore the relationships between these health outcomes and sleep parameters in children with sleep apnea syndrome, utilizing multiomics approaches. Our directional hypothesis posited that sleep apnea syndrome leads to adverse health outcomes, while adenotonsillectomy improves both sleep apnea and these health outcomes.
Methods: To evaluate the effects of sleep apnea syndrome and adenotonsillectomy on various health outcomes, we measured autonomic function using sleep hear rate variability (HRV) indices, inflammasome using multiplex suspension array, gut microbiome using 16S rRNA gene sequencing, and food literacy using the Short Food Frequency Questionnaire, both before and after adenotonsillectomy.
Results: Following adenotonsillectomy, significant improvements were observed in OSA-18 scores and major polysomnographic parameters. Adenotonsillectomy substantially improved three HRV indices (SDNN, total power, VLF power), 20 out of 27 inflammatory biomarkers, and gut microbiota and metabolic function. % changes in OSA-18 questionnaire score and VLF power serially mediated the relationships between change in tonsil size and % change in obstructive AHI, % change in interleukin-8 and % change in CCL5 were found to serially mediate the relationship between change in tonsil size and % change in AHI. Children with sleep apnea syndrome consumed fruit drinks with sugar, vegetables, sweets, chocolate, rice, and noodles more frequently than healthy children. Notably, younger age and reduced intake of butter/margarine on bread and noodles were independent predictors of cured sleep apnea syndrome in children undergoing adenotonsillectomy with routine educational counseling.
Conclusion: Through the use of multiomics approaches, we preliminarily found autonomic dysfunction and inflammasome appear to mediate the surgical effects. The study also identified sleep apnea syndrome-related unhealthy gut microbiota and dietary patterns, suggesting the potential benefits of educational counseling in childhood sleep apnea syndrome.
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