Upper airway and systemic inflammation in obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is associated with pharyngeal inflammation, but the coexistence of systemic inflammation is controversial. This study investigated whether local and systemic inflammatory biomarkers are related in patients with OSA. An uncontrolled extension to the study assessed the response to effective treatment. We recruited 89 patients with OSA (apnoea/hypopnoea index (AHI) >= 5 events.h(-1)), 28 snorers and 26 healthy controls. Pharyngeal lavage (PHAL) and plasma samples were collected at baseline and after a 1-year follow-up. Inflammatory cells were evaluated by flow cytometry; interleukin (IL)-6, IL-8 and tumour necrosis factor-a were evaluated by immunoassay. In PHAL, CD4(+) T-cells, IL-6 and IL-8 were higher in OSA patients than in snorers or healthy controls (p< 0.05). The AHI correlated with CD4(+), IL-6 and IL-8 in PHAL (all p-values < 0.05). There were no differences in the inflammatory biomarkers in plasma between the study groups and no relationship between plasma and PHAL biomarkers. Biomarkers decreased significantly in PHAL but not in plasma after 1 year of therapy with continuous positive airway pressure or surgery. In patients with OSA, increased levels of inflammatory biomarkers were found in PHAL, which were reduced with effective treatment. No simultaneous increase in plasma inflammatory biomarkers was found.