intranasal corticosteroids not recommended for most children with OSA: study

Obstructive sleep apnea occurs when the muscles in your throat that support soft tissues such as the tongue and soft palate temporarily relax. When these muscles relax, your airway narrows or closes and breathing is momentarily interrupted.

Intranasal corticosteroids (INCS) are often used to treat obstructive sleep apnea syndrome (OSAS) in children. However, their effectiveness has not been rigorously tested.

In this randomised, double-blind, placebo-controlled study, children aged 5 to 12 years (n=134) with obstructive sleep apnea syndrome were randomised 2:1 to 3 months of intranasal corticosteroids or placebo. Children in the Intranasal corticosteroids arm were then re-randomized to 9 months of Intranasal corticosteroids or placebo. Polysomnography, symptoms, and neurobehavioral findings were measured at baseline, 3, and 12 months. The primary outcome was the obstructive apnea-hypopnea index (OAHI) change at 3 months, available for 122 children. The secondary outcome was the obstructive apnea-hypopnea index change at 12 months, available for 70 children.

Results of the study:

• The median [IQR] age and obstructive apnea-hypopnea index at baseline for the entire group were 7.9 years and 5.8/hr.

• Obstructive apnea-hypopnea index changes at 3 and 12 months were not different between the 2 groups.

• Obstructive sleep apnea syndrome symptoms and neurobehavioral outcomes were not different between the Intranasal corticosteroids and placebo groups at 3 and 12 months.

• Obstructive apnea-hypopnea index decreased significantly from 7.2 to 3.7/hour in 38 children who received intranasal corticosteroids for 12 months.

Thus, Tapia et al. concluded that in children with obstructive sleep apnea syndrome, treatment with intranasal corticosteroids did not result in significant polysomnographic, neurobehavioral, and symptom changes at 3 and 12 months of treatment. 12 months of intranasal corticosteroid treatment resulted in a statistically significant but not clinically significant decrease in the obstructive apnea-hypopnea index.

Reference:

Ignacio E. Tapia et al. A trial of intranasal corticosteroids to treat the childhood obstructive sleep apnea syndrome. June 29, 2022DOI:https://doi.org/10.1016/j.chest.2022.06.026

Keywords:

Intranasal, corticosteroids, children, obstructive, sleep, apnea, Randomized Controlled Trial, Double-Blind Method, Intention, Treat, Analysis, Fluticasone, Ignacio E. Tapia, Justine Shults, Christopher M. Cielo, Andrea B. Kelly, Lisa M. Elden, Jonathan M. Spergel, Ruth M. Bradford, Mary Anne Cornaglia, Laura M. Sterni, Jerilynn Radcliffe, CHEST journal