Obstructive sleep apnea is highly prevalent in children and usually initially treated by adenotonsillectomy. Non-surgical alternatives for mild OSA primarily consisting of anti-inflammatory approaches have emerged, but their efficacy has not been extensively assessed.
A retrospective review of clinically and polysomnographically diagnosed OSA patients treated between 2007-2012 was performed to identify otherwise healthy children ages 2 to 14 years fulfilling the criteria for mild OSA who were treated with a combination of oral montelukast (OM) and intranasal corticosteroid (ICS) for 12 weeks (Tx), with continued OM in a subset for 6-12 months.
A total of 3,071 children were diagnosed with OSA, of whom 836 fulfilled mild OSA criteria and 752 received Tx. Overall, beneficial effects occurred in >80% with non-adherence being documented in 61 children and T&A 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 (>7 years; OR: 2.3; 95% CI: 1.43-4.13; p<0.001) and obese children (BMI z score >1.65; OR: 6.3; 95% CI: 4.23-11.18; p<0.000001).) were significantly more likely to be non-responders.
A combination of ICS and OM as initial treatment for mild OSA appears to provide an effective alternative to T&A, particularly in younger and non-obese children. These results support implementation of multicenter randomized trials to more definitively establish the role of Tx in pediatric OSA.