Antiinflammatory Therapy Outcomes for Mild OSA in Children

• Published in: Chest Vol. 146; no. 1; pp. 88 - 95
• Main Authors: Kheirandish-Gozal, Leila, MD, Bhattacharjee, Rakesh, MD, Bandla, Hari P.R., MD, FCCP, Gozal, David, MD, FCCP
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2014; American College of Chest Physicians
• Subjects: Adolescent; Anti-Inflammatory Agents - therapeutic use; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Original Research; Polysomnography; Pulmonary/Respiratory; Quality of Life; Retrospective Studies; Severity of Illness Index; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - drug therapy; Sleep Apnea, Obstructive - physiopathology; Treatment Outcome; nocturnal polysomnography; AHI; RCT; Sp o 2; arterial oxygen saturation; apnea-hypopnea index; oral montelukast; T&A; randomized controlled trial; intranasal corticosteroid; NPSG; TST; adenotonsillectomy; ICS; total sleep time; OM; Spo2
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.13-2288

BACKGROUND OSA is highly prevalent in children and usually initially treated by adenotonsillectomy. Nonsurgical alternatives for mild OSA primarily consisting of antiinflammatory approaches have emerged, but their efficacy has not been extensively assessed. METHODS A retrospective review of clinically and polysomnographically diagnosed patients with OSA treated between 2007 and 2012 was performed to identify otherwise healthy children ages 2 to 14 years who fulfilled the criteria for mild OSA and who were treated with a combination of intranasal corticosteroid and oral montelukast (OM) for 12 weeks (ICS + OM). A subset of children continued OM treatment for 6 to 12 months. RESULTS A total of 3,071 children were diagnosed with OSA, of whom 836 fulfilled mild OSA criteria and 752 received ICS + OM. Overall, beneficial effects occurred in > 80% of the children, with nonadherence being documented in 61 children and adenotonsillectomy being ultimately performed in 12.3%. Follow-up polysomnography in a subset of 445 patients showed normalization of sleep findings in 62%, while 17.1% showed either no improvement or worsening of their OSA. Among the latter, older children (aged > 7 years; OR, 2.3; 95% CI, 1.43-4.13; P < .001) and obese children (BMI z -score > 1.65; OR: 6.3; 95% CI, 4.23-11.18; P < .000001) were significantly more likely to be nonresponders. CONCLUSIONS A combination of ICS + OM as initial treatment of mild OSA appears to provide an effective alternative to adenotonsillectomy, particularly in younger and nonobese children. These results support implementation of multicenter randomized trials to more definitively establish the role of ICS + OM treatment in pediatric OSA.