Effect of adenotonsillectomy on c-reactive protein levels in children with obstructive sleep apnea: A meta-analysis

Objective: Children with obstructive sleep apnea syndrome (OSAS) have increased systemic inflammation, as assessed by c-reactive protein (CRP), and are at risk for substantial end-organ damage. Previous studies assessing the effect of adenotonsillectomy (T&A) on CRP in children with OSAS have yielded conflicting results. Therefore, the purpose of the current investigation was to perform a meta-analysis of the effect of T&A on CRP in children with OSAS and explore possible moderating factors. Methods: Multiple databases (PubMed, CINAHL, and Cochrane) were searched for relevant studies. Effective size was calculated with standardized mean differences (SMD) and analyzed with random-effects model. Moderators were examined with mixed-effects models. Results: Overall, T&A significantly reduced CRP (SMD = -0.79, 95% CI -1.33 to -0.25). We found significant between-study heterogeneity (Cochran's Q = 54.6, df = 7, p < 0.001; I2 = 90.7%, 95% CI 77.5-98.2%; and H2 = 10.7, 95% CI 4.5-55.7). We did not find evidence of publication bias or significant effects of tested moderators (study year, study size, age, gender, obesity, apnea-hypopnea index, oxygen nadir, pre-surgical CRP, follow-up duration). Conclusions: The results of the current study indicate that T&A significantly reduces CRP levels in children with OSAS. Despite the presence of significant between-study heterogeneity, we did not identify any significant moderating factors. Published by Elsevier B.V.