Intranasal Treatments for Children With Sleep-Disordered Breathing: The MIST+ Randomized Clinical Trial.

Area of Science:

• Pediatric Pulmonology
• Sleep Medicine
• Clinical Trials

Background:

• Obstructive sleep apnea (OSA) is common in children, often requiring adenotonsillectomy.
• Medical treatments offer potential to manage symptoms and reduce surgical necessity.

Purpose of the Study:

• To evaluate the efficacy of intranasal steroids (INS) versus saline in children with persistent obstructive sleep-disordered breathing (OSDB) symptoms.
• To compare symptom resolution rates after a 6-week saline run-in followed by 6 weeks of INS or continued saline.

Main Methods:

• A double-blind, placebo-controlled, randomized clinical trial was conducted in Australia.
• Children aged 3-12 years with persistent OSDB symptoms after a 6-week saline run-in were randomized to INS or saline for an additional 6 weeks.
• Primary outcome was symptom resolution, with secondary outcomes including behavior and quality of life.

Main Results:

• Of 139 children completing the run-in, 29.5% achieved symptom resolution with saline alone.
• Among 93 randomized children, symptom resolution rates were similar between INS (35.6%) and saline (36.4%) groups.
• No significant difference in symptom resolution or secondary outcomes was observed between INS and saline groups.

Conclusions:

• Six weeks of intranasal saline alone resolved OSDB symptoms in nearly one-third of children.
• An additional 6 weeks of INS or saline provided no added benefit, with overall resolution around 50%.
• Intranasal saline is an effective short-term first-line treatment for pediatric OSDB, warranting a 3-month trial before considering further interventions.