Chest
Volume 135, Issue 6, June 2009, Pages 1496-1501
Journal home page for Chest

Original Research
Sleep Medicine
Urine Concentrations of Cysteinyl Leukotrienes in Children With Obstructive Sleep-Disordered Breathing

https://doi.org/10.1378/chest.08-2295Get rights and content

Background

Adenotonsillar tissue of children with obstructive sleep-disordered breathing has increased content of cysteinyl leukotrienes and expression of CysLTs receptors. Furthermore, CysLTs concentrations in the nasal exhaled breath condensate of children with sleep apnea are elevated.

Objective

To investigate the relationship between urine levels of CysLTs and severity of SDB in children.

Methods

Morning urine concentrations of CysLTs were measured in children with symptoms of SDB and in control subjects with recurrent tonsillitis and without snoring who underwent polysomnography and were expressed in pg/mL per mg/dL of urine creatinine.

Results

Nineteen children with moderate-to-severe SDB (mean [± SD] age, 5.4 ± 1.6 years; obstructive apnea-hypopnea index [OAHI]: 14.4 ± 9.6 episodes/h), 29 subjects with mild SDB (5.1 ± 1.5 years; OAHI: 2.9 ± 0.8 episodes/h), 26 children with primary snoring (PS) [7 ± 2.6 years; OAHI: 1.1 ± 0.3 episodes/h], and 18 control subjects (6.4 ± 2.5 years; OAHI: 0.7 ± 0.3 episodes/h) were studied. Children with moderate-to severe SDB had higher log-transformed urine CysLTs levels than those with mild SDB, PS, or control subjects (2.39 ± 0.51 vs 2.06 ± 0.26 vs 2.11 ± 0.25 vs 1.86 ± 0.28; p < 0.05). Log-transformed CysLTs concentration, tonsillar size, and body mass index z score were significant predictors of log-transformed OAHI (p < 0.01).

Conclusions

Urine excretion of CysLTs is related to SDB severity in children. This finding indicates that 5-lipoxygenase pathway products participate in the pathogenesis of obstructive sleep apnea in childhood or alternatively that SDB promotes CysLTs biosynthesis.

Section snippets

Participants

Children referred to the sleep disorders laboratory for polysomnography due to symptoms of SDB were recruited. Children with a history of recurrent tonsillitis and without snoring participated as control subjects. Exclusion criteria for both patients and control subjects were cardiovascular, neuromuscular, or genetic disorders; acute symptoms or signs of asthma or respiratory tract infection (eg, bronchiolitis); symptoms or signs of other acute or chronic inflammatory disorders; eczema, and

Subjects' Characteristics and Polysomnography Findings

One hundred children were considered for participation in the study, and 8 were excluded due to acute symptoms of asthma (3), current use of antihistamines or montelukast (3), and history of eczema (2). Thus, a total of 92 subjects (43 female subjects; 46.7%) were recruited, and Table 1 summarizes their characteristics. Eighteen children were control subjects without snoring (mean age, 6.4 ± 2.5 years), 26 subjects had PS (mean age, 7 ± 2.6 years), 29 subjects had mild SDB (mean age, 5.1 ± 1.5

Discussion

CysLTs have been mainly studied for their role in asthma and allergic rhinitis.20, 21 However, recently published investigations have revealed increased CysLTs activity in the upper airway of children with SDB.2, 3, 4, 10 In the present report, urine levels of CysLTs were significantly associated with severity of SDB. In addition, CysLTs, tonsillar size, and BMI z score were significant predictors of OAHI.

Increased immunostaining for CysLTs receptors (type 1 CysLT receptor [LT1-R] and type 2

References (42)

  • L Lavie

    Obstructive sleep apnoea syndrome: an oxidative stress disorder

    Sleep Med Rev

    (2003)
  • SA McColley et al.

    High prevalence of allergic sensitization in children with habitual snoring and obstructive sleep apnea

    Chest

    (1997)
  • M Kalra et al.

    Atopy as a risk factor for habitual snoring at age 1 year

    Chest

    (2006)
  • R Arens et al.

    Pathophysiology of upper airway obstruction: a developmental perspective

    Sleep

    (2004)
  • AD Goldbart et al.

    Leukotriene modifier therapy for mild sleep-disordered breathing in children

    Am J Respir Crit Care Med

    (2005)
  • EI Alexopoulos et al.

    Nasal corticosteroids for children with snoring

    Pediatr Pulmonol

    (2004)
  • L Kheirandish-Gozal et al.

    Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome

    Pediatrics

    (2008)
  • L Kheirandish et al.

    Intranasal steroids and oral leukotriene modifier therapy in residual sleep-disordered breathing after tonsillectomy and adenoidectomy in children

    Pediatrics

    (2006)
  • M Berlucchi et al.

    The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study

    Pediatrics

    (2007)
  • A Oommen et al.

    Urinary leukotriene E4 in preschool children with acute clinical viral wheeze

    Eur Respir J

    (2003)
  • CL Ogden et al.

    Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version

    Pediatrics

    (2002)
  • Cited by (0)

    This research was funded by the University of Thessaly Research Committee.

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

    View full text