Global Journal of Health Science; Vol. 10, No. 9; 2018 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education 97 The Effect of Vitamin C Therapy Towards Malondialdehyde Plasma Content on Chronic Tonsillitis Patients With Risk of Obstructive Sleep Apnea Syndrome Sutji Pratiwi Rahardjo Hiro 1 , Hiro Salomo Mangape 1 , Abdul Qadar Punagi 1 & Andi Nilawati Usman 2,3 1 Nose, and Throat Department, Head and Neck Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia 2 Halal Center, Hasanuddin University, Makassar, Indonesia 3 Public Health, Mandala Waluya College, Indonesia Correspondence: Andi Nilawati Usman, Faculty of Public Health, Hasanuddin University, Makassar 90245, Indonesia. Tel: 628-525-599-0153. E-mail : nilawatiandi@gmail.com Received: May 26, 2018 Accepted: July 29, 2018 Online Published: August 23, 2018 doi:10.5539/gjhs.v10n9p97 URL: https://doi.org/10.5539/gjhs.v10n9p97 Abstract Introduction: Sleep Apnea Syndrome is a syndrome with an episode of apnea or hypopnea during sleep. The objective of this study was to investigate the effect of the vitamin C therapy to plasma Malondialdehyde (MDA) level in patients with chronic tonsillitis who have a risk factor of Obstructive Sleep Apnea Syndrome (OSAS), measured pre and post-therapy. Methods: The design of this study was a clinical trial with pre-test and post-test control group. This study was conducted in Dr. Wahidin Sudirohusodo Hospital and Hasanuddin University Teaching Hospital in Makassar and 30 subjects was enrolled (20 subjects were patients with chronic tonsillitis and OSAS, and 10 subjects were control). The measurement of plasma MDA level was obtained using ELISA method. The data were analyzed using the Mann-Whitney test and Chi-square test. Results: The results of this study showed a decreasing level of plasma MDA in patients with chronic tonsillitis and OSAS after the vitamin C therapy. However, there was no significant difference between patients who had not received vitamin C therapy. Conclusion: The intervention of vitamin C in chronic tonsillitis patients and can reduce levels of plasma MDA. Keywords: plasma MDA level, chronic tonsillitis, obstructive sleep apnea syndrome (OSAS), vitamine C 1. Introduction Sleep apnea syndrome is a syndrome with an episode of apnea or hypopnea during sleep. Apnea can be caused by central abnormalities, airway obstruction, or both. Obstructive apnea is a condition with cessation of airflow in the nose and mouth with breathing effort, whereas central apnea is a respiratory cessation that is not accompanied by breathing effort due to the absence of breath stimulation. Hypoventilation obstruction is caused by partial obstruction of air flow causing hypoventilation and hypoxia. The term hypoventilation obstruction is used to indicate the presence of hypopnea, which implies a reduction in airflow (Rosen et al., 2012; Spicuzza, Caruso, & Di Maria, 2015; Swedish Council on Health Technology, 2007). Obstructive sleep apnea (OSA) is characterized by a period of repeated upper airway collapse that leads to a hypoxia / reoxygenation cycle causing increased oxygen species formation by oxidative stress (Patil, Schneider, Schwartz, & Smith, 2007; Sunitha & Aravindkumar, 2009). Intermittent hypoxia can lead to increased oxygen-free radical formation. One of the lipid oxidation products is Malondialdehyde (MDA) which is used as biomarker on oxidative stress test. MDA is an unsaturated fatty acid oxidation product by free radicals. Increased MDA concentration indicates free radicals involvement. Oxidation reactions cause oxidative damage eventually, resulting in cell damage and death (Behn, Araneda, Llanos, Celedon, & Gonzalez, 2007; Chantharaksri, Tonsuwonnont, Fucharoen, & Wasi, 1992; Freudenthaler, Schreeb, Wiese, Pilz, & Gleiter, 2002). Plasma MDA levels as a free radical biomarker was higher in patients with chronic tonsillitis who had OSAS than who had not OSAS (Asker et al., 2015; Kang, Jung, & Kim, 2013; Tauman, Lavie, Greenfeld, & Sivan, 2014).