Frontiers in pediatrics · 2026
Independent association of serum IgA levels with moderate-to-severe obstructive sleep apnea in children with adenotonsillar hypertrophy.
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Xia Fei, Xia Zhongfang, Huang Tao, Li Dong
Аннотация
BACKGROUND: Adenotonsillar hypertrophy (ATH) is the leading cause of obstructive sleep apnea (OSA) in children. While the role of allergic inflammation (IgE-mediated) has been widely studied, the contribution of mucosal immunity-specifically Immunoglobulin A (IgA)-to disease severity remains unclear. This study aimed to investigate the association between serum immune markers and OSA severity and to construct a multivariate diagnostic model for moderate-to-severe disease.
METHODS: A total of 110 children diagnosed with ATH were enrolled in this cross-sectional study. Based on polysomnography (PSG) results and the 2020 Chinese Guidelines for Diagnosis and Treatment of Childhood OSA, participants were divided into a Mild/No OSA group (n = 65) and a Moderate-to-Severe OSA group (n = 45). Serum immunoglobulins (IgA, IgE, IgG, IgM) and complement components (C3c, C4) were analyzed. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were performed.
RESULTS: The Moderate-to-Severe group exhibited significantly lower lowest oxygen saturation (LSpO2) [0.85 (0.81, 0.89) vs. 0.89 (0.86, 0.91), P < 0.001], larger adenoids [A/N ratio: 0.77 (0.71, 0.80) vs. 0.65 (0.62, 0.75), P < 0.001], and a higher proportion of Grade III tonsils (28.9% vs. 12.3%, P < 0.001). Notably, serum IgA levels were significantly elevated in the Moderate-to-Severe group (2.05 ± 0.55 vs. 1.79 ± 0.75 g/L, P = 0.032), while IgE showed no significant difference. Multivariate logistic regression identified LSpO2 (OR = 0.853, P = 0.005) as a protective factor, while Tonsillar Hypertrophy (ORs 27.09-45.54) and IgA (OR = 2.520, 95% CI: 1.033-6.146, P = 0.042) were independent risk factors. A combined model incorporating these variables achieved an Area Under the Curve (AUC) of 0.852.
CONCLUSION: Elevated serum IgA is an independent associated factor of moderate-to-severe OSA in children with ATH, suggesting a potential mechanism involving chronic mucosal inflammation distinct from atopy. A combined diagnostic model involving IgA, anatomical metrics, and oximetry provides high diagnostic value.
METHODS: A total of 110 children diagnosed with ATH were enrolled in this cross-sectional study. Based on polysomnography (PSG) results and the 2020 Chinese Guidelines for Diagnosis and Treatment of Childhood OSA, participants were divided into a Mild/No OSA group (n = 65) and a Moderate-to-Severe OSA group (n = 45). Serum immunoglobulins (IgA, IgE, IgG, IgM) and complement components (C3c, C4) were analyzed. Logistic regression and Receiver Operating Characteristic (ROC) curve analyses were performed.
RESULTS: The Moderate-to-Severe group exhibited significantly lower lowest oxygen saturation (LSpO2) [0.85 (0.81, 0.89) vs. 0.89 (0.86, 0.91), P < 0.001], larger adenoids [A/N ratio: 0.77 (0.71, 0.80) vs. 0.65 (0.62, 0.75), P < 0.001], and a higher proportion of Grade III tonsils (28.9% vs. 12.3%, P < 0.001). Notably, serum IgA levels were significantly elevated in the Moderate-to-Severe group (2.05 ± 0.55 vs. 1.79 ± 0.75 g/L, P = 0.032), while IgE showed no significant difference. Multivariate logistic regression identified LSpO2 (OR = 0.853, P = 0.005) as a protective factor, while Tonsillar Hypertrophy (ORs 27.09-45.54) and IgA (OR = 2.520, 95% CI: 1.033-6.146, P = 0.042) were independent risk factors. A combined model incorporating these variables achieved an Area Under the Curve (AUC) of 0.852.
CONCLUSION: Elevated serum IgA is an independent associated factor of moderate-to-severe OSA in children with ATH, suggesting a potential mechanism involving chronic mucosal inflammation distinct from atopy. A combined diagnostic model involving IgA, anatomical metrics, and oximetry provides high diagnostic value.