Sleep-Disordered Breathing (SDB) affects at least 12% of otherwise healthy children and is associated with significant morbidity. Currently, the American Academy of Pediatrics (AAP) recommends referral to a specialist for children with significant SDB symptoms.
Treatment options to date have included adenotonsillectomy, nasal steroids, and nasal dilator strips. A new study, led by a team of researchers from the Department of Pediatrics at the University of Melbourne, Australia, set out to determine whether intranasal mometasone furoate is more effective than intranasal saline for improving symptoms and quality of life in children with SDB.
Breathing Easier
The team conducted a double-blind, randomized clinical trial of 276 children with SDB. The participants were randomly assigned to receive either mometasone furoate or sodium chloride (saline) intranasally, one spray per nostril daily, in identical bottles. The primary outcome was the resolution of significant SDB symptoms (ie, reduction to a level no longer requiring referral to a specialist as per the AAP guidelines) at 6 weeks, measured by parental report of symptoms using the SDB Score.The results of the trial showed that resolution of significant SDB symptoms occurred in 44% of participants in the mometasone group and 41% of participants in the saline group. This suggests that there was no difference in treatment effect between intranasal mometasone and saline for the management of SDB symptoms. The main adverse effects reported were epistaxis (nosebleeds) and nasal itch/irritation.
The results of this trial suggest that almost one-half of children with SDB could be initially managed in the primary care setting, without referral to specialist services, as is currently recommended. Intranasal saline or corticosteroid may resolve SDB symptoms in almost one-half of children and could be a viable option for primary care. This study provides promising results for the treatment of SDB in children.
The findings could have important implications for the management of SDB in the future and could lead to improved quality of life for children with SDB. Further research is needed to determine the long-term effects of intranasal steroids and saline on SDB in children, and to identify other treatments that could help to improve symptoms and quality of life.
__________
JAMA, Jan-17-23