Original Research |

Anti-Inflammatory Therapy Outcomes for Mild OSA in Children

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

Section of Pediatric Sleep Medicine, Department of Pediatrics, Biological Sciences Division, Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637 (Kheirandish-Gozal, Bhattacharjee, Bandla, Gozal)

Corresponding author: David Gozal, MD, FAAP, Department of Pediatrics, Comer Children's Hospital, The University of Chicago 5721 S. Maryland Avenue, Chicago, IL 60637; E-mail: dgozal@peds.bsd.uchicago.edu

Funding Sources: LKG and DG are supported by National Institutes of Health grants HL-65270, HL-086662, and HL-107160.

Chest. 2014. doi:10.1378/chest.13-2288
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Background:  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.

Methods:  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.

Results:  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.

Conclusions:  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.

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