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Published on: December 6, 2016
Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis
Yuxiao Zhang1, Siqi Leng2, Qian Hu1
1Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China.
Insights
The combination of mometasone and montelukast is the most effective treatment for pediatric obstructive sleep apnea (OSA), significantly improving the apnea-hypopnea index (AHI). This finding offers a promising therapeutic option for children with OSA.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Pharmacology
Background:
- Pediatric obstructive sleep apnea (OSA) significantly impacts child health and development.
- A comprehensive evaluation of pharmacological treatments for pediatric OSA is lacking.
Purpose of the Study:
- To conduct a systematic review and network meta-analysis of pharmacological interventions for pediatric OSA.
- To identify the most effective drug treatments for improving the apnea-hypopnea index (AHI) in children.
Main Methods:
- Systematic review and Bayesian network meta-analysis of 17 randomized controlled trials (RCTs) involving 1367 children.
- Searched major databases (PubMed, Web of Science, Embase, Cochrane, CNKI) from 1950 to November 2022.
- Primary outcome: improvement in AHI; secondary outcomes: adverse events and SaO2.
Main Results:
- Mometasone + Montelukast, Budesonide, and Montelukast showed significant improvements in AHI compared to placebo.
- Mometasone + Montelukast demonstrated the highest efficacy, with a WMD of -4.74 for AHI.
- Mometasone + Montelukast also achieved high SUCRA values for AHI (85.0%) and SaO2 (91.0%).
Conclusions:
- The combination of mometasone furoate nasal spray and montelukast sodium is the most effective intervention for pediatric OSA.
- Further research is warranted to assess long-term efficacy and safety of these interventions.
Importance:
Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking.
Objective:
This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population.
Data Sources:
PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA.
Study Selection:
Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children.
Data Extraction And Synthesis:
Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839).
Main Outcome(S) And Measure(S):
The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2).
Results:
17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %).
Conclusions And Relevance:
The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
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