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Do systemic corticosteroids effectively treat obstructive sleep apnea secondary to adenotonsillar hypertrophy?
S A Al-Ghamdi1, J J Manoukian, A Morielli
1Department of Otolaryngology, McGill University/Montreal Children's Hospital, Quebec, Canada.
Insights
A short course of oral prednisone did not effectively treat pediatric obstructive sleep apnea syndrome (OSAS) caused by adenotonsillar hypertrophy (ATH). Most children still required adenotonsillectomy despite corticosteroid treatment.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Pulmonology
Background:
- Adenotonsillar hypertrophy (ATH) is a common cause of obstructive sleep apnea syndrome (OSAS) in children.
- Current treatment for pediatric OSAS due to ATH typically involves surgical removal of tonsils and adenoids.
- The potential role of medical management, such as corticosteroids, remains an area of investigation.
Purpose of the Study:
- To evaluate the efficacy of a short course of systemic corticosteroids in treating pediatric OSAS secondary to ATH.
- To assess the impact of oral prednisone on OSAS symptomatology, severity, and adenotonsillar size.
Main Methods:
- An open-label pilot study was conducted with children aged 1-12 years diagnosed with OSAS and ATH.
- Participants received a 5-day course of oral prednisone (1.1 mg/kg/day).
- Standardized assessments of symptoms, OSAS severity (apnea/hypopnea index), and adenotonsillar size were performed before and after treatment.
Main Results:
- Only one out of nine children showed sufficient improvement to avoid adenotonsillectomy.
- No significant improvement in OSAS symptomatology or polysomnographic indices was observed after corticosteroid treatment.
- Corticosteroid treatment resulted in minimal reduction in tonsillar and adenoidal size, with no significant increase in nasopharyngeal airway size.
Conclusions:
- A short course of oral prednisone is ineffective for treating pediatric OSAS caused by ATH.
- Symptomatic and objective improvements in OSAS were only achieved after adenotonsillectomy.
- Systemic corticosteroids do not appear to be a viable medical alternative to surgery for this condition.
Abstract:
To determine if pediatric obstructive sleep apnea syndrome (OSAS) caused by adenotonsillar hypertrophy (ATH) could be treated by a short course of systemic corticosteroids, we conducted an open-label pilot study in which standardized assessments of symptomatology, OSAS severity, and adenotonsillar size were performed before and after a 5-day course of oral prednisone, 1.1+/-0.1 (+/-SE) mg/kg per day. Outcome measures included symptom severity, adenotonsillar size, and polysomnographic measures of OSAS. Selection criteria included age from 1 to 12 years, ATH, symptomatology suggesting OSAS, an apnea/hypopnea index (AHI) > or = 3/hour, and intent to perform adenotonsillectomy. Only one of nine children showed enough improvement to avoid adenotonsillectomy. Symptomatology did not improve after corticosteroid treatment but did after removal of tonsils and adenoids. Polysomnographic indices of OSAS severity did not improve after corticosteroid treatment. After corticosteroids, tonsillar size decreased in only two patients, adenoidal size was only marginally reduced, and the size of the nasopharyngeal airway was not significantly increased. These results suggest that a short course of prednisone is ineffective in treating pediatric OSAS caused by ATH.