Anti-inflammatory drugs for the treatment of obstructive sleep apnea in children

Obstructive sleep apnea (OSA) is the partial or complete blockage of the upper airways during sleep and affects about 1% to 4% of children. The most common underlying reason for OSA in children is enlarged tonsils. Surgical removal of the enlarged tonsils is the therefore currently the treatment standard. In milder cases of OSA, treatment with anti-inflammatory drugs to reduce the size of the tonsils is an alternative to surgery. The aim of this review was to evaluate the effectiveness of anti-inflammatory drugs for the treatment of OSA in children between one and 16 years of age. A comprehensive literature search identified three relevant studies. Very limited evidence from these studies suggests that steroids inhaled through the nose may reduce symptoms of OSA in children. Further studies are needed to evaluate anti-inflammatory drugs for OSA in children.

Authors' conclusions: 

A single small study has found a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety and efficacy data are not available yet. Further RCTs are needed to evaluate anti-inflammatory drugs for OSA in children.

Read the full abstract...
Background: 

Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy the most common underlying risk factor. Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA.

Objectives: 

To assess the efficacy of anti-inflammatory drugs for the treatment of OSA in children.

Search strategy: 

We identified trials using searches of the Cochrane Airways Group Specialized Register, MEDLINE (1950 to 2010), EMBASE (1988 to 2010), CINAHL (1982 to 2010), CENTRAL (1964 to 2010), Web of Science (1900 to 2010), LILACS (1982 to 2010) and International Pharmaceutical Abstracts (IPA) (1970 to 2010).

Selection criteria: 

Randomized controlled trials (RCTs) comparing anti-inflammatory drugs against placebo, other anti-inflammatory drugs, or other treatment in children between one and 16 years with objectively diagnosed OSA (Apnea Hypopnea Index (AHI) ≥ 1/hour (h)).

Data collection and analysis: 

Both authors independently performed data extraction and quality assessment. It was not possible to combine data from the included studies; we summarized data in a narrative fashion.

Main results: 

We included three RCTs. The first study was a six-week parallel-group trial (25 participants, mean age 3.8 years, mean AHI 10.8/h) of intranasal fluticasone versus placebo showed a statistically significant effect of the drug on improving the AHI. The second study compared intranasal budesonide with placebo in a six-week cross-over trial (62 participants, mean age 8.2 years, mean AHI 3.7/h). The authors reported an advantage of the drug over placebo in reducing the AHI. However, the patients were not analyzed as randomized so the result must be interpreted with caution. No valid group comparisons were reported for the third trial (30 participants, oral montelukast versus placebo in a 12-week parallel-group trial), which has so far only been published as an abstract.

Share/Save