Faculty Collaboration Database

Antiinflammatory therapy outcomes for mild OSA in children. Chest 2014 Jul;146(1):88-95

Date

02/08/2014

Pubmed ID

24504096

Pubmed Central ID

PMC4077412

DOI

10.1378/chest.13-2288

Scopus ID

2-s2.0-84903646202 (requires institutional sign-in at Scopus site)   97 Citations

Abstract

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.

Author List

Kheirandish-Gozal L, Bhattacharjee R, Bandla HPR, Gozal D

Author

Hari Bandla MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anti-Inflammatory Agents
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Male
Polysomnography
Quality of Life
Retrospective Studies
Severity of Illness Index
Sleep Apnea, Obstructive
Treatment Outcome