Clin Exp Otorhinolaryngol.  2021 Nov;14(4):390-398. 10.21053/ceo.2020.02250.

Effect of Obstructive Sleep Apnea on Immunity in Cases of Chronic Rhinosinusitis With Nasal Polyps

• Kim DK
• Lee BC
• Park KJ
• Son GM

• KMID: 2522430
• DOI: http://doi.org/10.21053/ceo.2020.02250

Abstract

Objectives
. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a more severe inflammatory form of CRS that often coexists with obstructive sleep apnea (OSA). However, little is known about the relationship between OSA and the immune profile in patients with CRSwNP. We aimed to investigate the immune profile of patients with CRSwNP according to OSA severity.
Methods
. This study included 63 patients with CRSwNP and nine control subjects. Protein levels of inflammatory mediators were determined using multiplex immunoassays. All patients underwent standard polysomnography.
Results
. In patients with eosinophilic CRSwNP (ECRSwNP), interleukin (IL)-6 and chemokine [C-X-C motif] ligand (CXCL)-1 (type 1 immune-related markers) were upregulated in cases of moderate-to-severe OSA. Additionally, IL-4, IL-13, C-C motif chemokine (CCL)-11, CCL-24 (type 2 immune-related markers), and IL-17A (a type 3 immune-related marker) were present at elevated levels in patients with moderate-to-severe OSA. Although there were no significant differences in type 1, 2, or 3 immune-related markers among patients with non-eosinophilic CRSwNP (NECRSwNP) according to the severity of OSA, transforming growth factor-beta expression was higher in those with moderate-to-severe OSA. Furthermore, in ECRSwNP with moderate-to-severe OSA, associations were detected between serum markers and some upregulated inflammatory markers.
Conclusion
. OSA may increase the heterogeneity of the immune profile (types 1, 2, and 3) in patients with ECRSwNP, but not in those with NECRSwNP.

Keyword

Eosinophils; Nasal Polyps; Rhinitis; Sinusitis; Sleep; Sleep Apnea Syndromes

Figure

• 

  Fig. 1. Expression of inflammatory mediators in nasal tissues according to the phenotype of chronic rhinosinusitis: (A) type 1 immune-related markers, (B) type 2 immune-related markers, (C) type 3 immune-related markers (results reported as median and interquartile range). ECRSwNP, eosinophilic chronic rhinosinusitis with nasal polyps; NECRSwNP, non-eosinophilic chronic rhinosinusitis with nasal polyps; IFN, interferon; TNF, tumor necrosis factor; MPO, myeloperoxidase; CXCL, chemokine [C-X-C motif] ligand; IL, interleukin; CCL, C-C motif chemokine; ECP, eosinophil cationic protein; TGF, transforming growth factor. *P<0.05, **P<0.01, ***P<0.001.

• 

  Fig. 2. Expression of inflammatory mediators in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) patients according to the severity of OSA: (A) type 1 immune-related markers, (B) type 2 immune-related markers, (C) type 3 immune-related markers (results reported as median and interquartile range). OSA, obstructive sleep apnea; IFN, interferon; TNF, tumor necrosis factor; MPO, myeloperoxidase; CXCL, chemokine [C-X-C motif] ligand; IL, interleukin; CCL, C-C motif chemokine; ECP, eosinophil cationic protein; TGF, transforming growth factor.

• 

  Fig. 3. Expression of inflammatory mediators in non-eosinophilic chronic rhinosinusitis with nasal polyps (NECRSwNP) patients according to the severity of OSA: (A) type 1 immune-related markers, (B) type 2 immune-related markers, (C) type 3 immune-related markers (results reported as median and interquartile range). OSA, obstructive sleep apnea; IFN, interferon; TNF, tumor necrosis factor; MPO, myeloperoxidase; CXCL, chemokine [C-X-C motif] ligand; IL, interleukin; CCL, C-C motif chemokine; ECP, eosinophil cationic protein; TGF, transforming growth factor.

• 

  Fig. 4. Correlations of upregulated inflammatory mediators and serum markers in eosinophilic chronic rhinosinusitis with nasal polyps (ECRSwNP) patients who had moderate-to-severe obstructive sleep apnea (OSA). (A) Associations of CRP with IL-6, CXCL-1, IL-17A. (B) Associations of serum eosinophil count with IL-4, IL-13, CCL-11, and CCL-24. CRP, C-reactive protein; IL, interleukin; CXCL, chemokine [C-X-C motif] ligand; CCL, C-C motif chemokine.

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