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Published on: December 6, 2016
Anti-inflammatory medications for obstructive sleep apnea in children
Stefan Kuhle1, Michael S Urschitz
1School of Public Health, University of Alberta, 650 University Terrace, 8303-112 Street, Edmonton, Alberta, Canada, T6G 2T4.
Insights
Anti-inflammatory drugs show short-term benefits for treating obstructive sleep apnea (OSA) in children. Further research is needed to confirm long-term safety and effectiveness for pediatric OSA management.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Pharmacology
Background:
- Obstructive sleep apnea (OSA) affects 1-4% of children, often linked to enlarged tonsils and adenoids.
- Surgery is the primary treatment, but carries risks and recurrence rates up to 20%.
- Non-surgical options, including anti-inflammatory agents, are being explored for pediatric OSA.
Purpose of the Study:
- To evaluate the effectiveness of anti-inflammatory medications in treating childhood obstructive sleep apnea (OSA).
Main Methods:
- Systematic review of randomized controlled trials (RCTs) comparing anti-inflammatory drugs to placebo or other treatments in children (1-16 years) with diagnosed OSA.
- Searches conducted across multiple databases (MEDLINE, EMBASE, CENTRAL, etc.) from inception to 2010.
- Data extraction and quality assessment performed independently; results summarized narratively due to inability to pool data.
Main Results:
- Three RCTs were included. One study showed intranasal fluticasone improved the Apnea Hypopnea Index (AHI) in children with mild-moderate OSA.
- Another study suggested intranasal budesonide reduced AHI compared to placebo, but results require cautious interpretation.
- A third trial on oral montelukast lacked valid group comparisons.
Conclusions:
- Limited evidence suggests a short-term benefit of anti-inflammatory drugs on AHI in pediatric OSA.
- Long-term safety and efficacy data are currently unavailable.
- Further high-quality RCTs are necessary to establish the role of anti-inflammatory drugs in treating childhood OSA.
Background:
Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy the most common underlying risk factor. Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA.
Objectives:
To assess the efficacy of anti-inflammatory drugs for the treatment of OSA in children.
Search Strategy:
We identified trials using searches of the Cochrane Airways Group Specialized Register, MEDLINE (1950 to 2010), EMBASE (1988 to 2010), CINAHL (1982 to 2010), CENTRAL (1964 to 2010), Web of Science (1900 to 2010), LILACS (1982 to 2010) and International Pharmaceutical Abstracts (IPA) (1970 to 2010).
Selection Criteria:
Randomized controlled trials (RCTs) comparing anti-inflammatory drugs against placebo, other anti-inflammatory drugs, or other treatment in children between one and 16 years with objectively diagnosed OSA (Apnea Hypopnea Index (AHI) ≥ 1/hour (h)).
Data Collection And Analysis:
Both authors independently performed data extraction and quality assessment. It was not possible to combine data from the included studies; we summarized data in a narrative fashion.
Main Results:
We included three RCTs. The first study was a six-week parallel-group trial (25 participants, mean age 3.8 years, mean AHI 10.8/h) of intranasal fluticasone versus placebo showed a statistically significant effect of the drug on improving the AHI. The second study compared intranasal budesonide with placebo in a six-week cross-over trial (62 participants, mean age 8.2 years, mean AHI 3.7/h). The authors reported an advantage of the drug over placebo in reducing the AHI. However, the patients were not analyzed as randomized so the result must be interpreted with caution. No valid group comparisons were reported for the third trial (30 participants, oral montelukast versus placebo in a 12-week parallel-group trial), which has so far only been published as an abstract.
Authors' Conclusions:
A single small study has found a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety and efficacy data are not available yet. Further RCTs are needed to evaluate anti-inflammatory drugs for OSA in children.
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