Original Research: Sleep Disorders |

Antiinflammatory Therapy Outcomes for Mild OSA in ChildrenAntiinflammatory Therapy for Mild OSA

Leila Kheirandish-Gozal, MD; Rakesh Bhattacharjee, MD; Hari P. R. Bandla, MD, FCCP; David Gozal, MD, FCCP
Author and Funding Information

From the Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL.

CORRESPONDENCE TO: David Gozal, MD, FCCP, Department of Pediatrics, Comer Children’s Hospital, The University of Chicago 5721 S Maryland Ave, Chicago, IL 60637; e-mail: dgozal@peds.bsd.uchicago.edu

FUNDING/SUPPORT: Drs Kheirandish-Gozal and Gozal are supported by the US National Institutes of Health [Grants HL-65270, HL-086662, and HL-107160].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2014;146(1):88-95. doi:10.1378/chest.13-2288
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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.

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