Differential regulation of metabolic markers in children diagnosed with OSA before and after ENT surgery

Obstructive sleep apnea (OSA) is a chronic condition characterized by frequent episodes of upper airway collapse during sleep. Its effect on nocturnal sleep quality and daytime activity is widely acknowledged. Increasingly, OSA has also been recognized as an independent risk factor for several clinical consequences including systemic hypertension, cardiovascular disease, stroke and abnormal glucose metabolism. Despite the numerous advancements in our understanding of the pathogenesis and clinical consequences of the disorder, the majority of those affected remain undiagnosed. simple queries of the patient or caregiver for the symptoms and signs of the disorder would help identify those in need of further diagnostic evaluation. With the numerous health consequences linked to OSA, if left untreated, it leads to excessive daytime sleepiness, cognitive dysfunction, impaired school performance and decrements in health related quality of life. Even though OSA in adults has been associated for several decades with increased risk for cardiovascular morbidities, it is only more recently that nocturnal elevation of systemic blood pressure and sustained diurnal hypertension severity-dependent changes in left ventricular geometry and function, and abnormal endothelial function have emerged and been recognized in children with OSA, along with exacerbated cardiovascular risk when insulin resistance is present. Therefore, evaluation of the potential cardiometabolic burden that is inherently assignable to OSA in children and improved understanding of its reversibility would be of clear importance considering that such morbidity is silent in children and manifests later in life. To understand the potentially adverse contributions of OSA to metabolic regulation in children, a prospective study of children with OSA and without OSA will be conducted. The following analysis will be preformed before and after treatment of OSA: fasting levels of blood glucose, insulin (FPI), high sensitivity C-reactive protein, and plasma lipid profile concentrations as well as proteomics analysis Upper airways surgery and removal of tonsils will be used as an alternative method for treating OSA, however, appropriate grading of OSA is limited and the need for biomarkers is dire. We will also attempt to identify potential markers that can be used to detect and grade OSA using a cohort of children with and without OSA undergoing surgical treatment.