Intranasal Saline Resolves OSDB Symptoms in Many Children: JAMA
According to a news study, intranasal use of saline alone has shown promise in clearing up symptoms of obstructive disordered breathing (OSDB) in a large percentage of children and may reduce the necessity for steroids or surgery in those cases. The study conducted in Australia demonstrated that nearly one-third of children experienced symptom resolution in 6 weeks of therapy with no additional benefit of intranasal steroids in half of those undergoing 12 weeks of intranasal saline therapy. The study was published in JAMA Pediatrics by Gillian M. and colleagues.
Currently, adenotonsillectomy is considered the first-line treatment for pediatric OSDB. Surgery, however, has risks and resource implications, raising interest in medical therapies, including intranasal steroids, either as alternatives or bridging treatments. Evidence is limited concerning how steroids compare with simpler interventions such as saline. We conducted a double-blind, placebo-controlled, randomized clinical trial at two specialist clinic sites in Australia. Children aged 3-12 years on waiting lists were enrolled from the outpatient clinics. Data were analyzed from January to June 2025. All participants underwent a run-in phase of 6 weeks of once-daily intranasal saline before randomization.
A total of 150 children were enrolled, with a mean age of 6.2 ± 2.3 years and a male predominance of 93/150 or 62%. Of the enrolled children, a total of 139 completed the saline run-in period. Of these, a total of 93 resolved their symptoms, with a score of -1 or better for SDB. A total of 47 were randomly assigned to once-daily intranasal mometasone furoate 50 µg, while a further 46 were randomly assigned to continued use of saline for the next 6 weeks. Principally, the primary endpoints were a measure of symptom resolution, which equated to having a score of -1 or worse on the SDB scale. Child behavior, quality of life, and need for surgeries were measures of the secondary endpoints.
Key findings
After the initial 6-week saline run-in, 41 of 139 children (29.5%) achieved symptom resolution.
Among the 93 randomized children, symptom resolution occurred in 35.6% (95% CI, 22.9%–50.6%) of the intranasal steroid group and 36.4% (95% CI, 23.5%–51.6%) of the saline group.
The risk difference between groups was −0.9% (95% CI, −20.7% to 19.0%; P = 0.93), showing no clinically or statistically significant benefit of intranasal steroids.
No differences were observed between groups in behavior, quality of life, or parental perception of the need for surgery.
Subgroup analyses did not identify any population more likely to benefit from steroid therapy.
Intranasal saline is an effective short-term first-line treatment for pediatric obstructive sleep-disordered breathing, with no additional benefit from intranasal steroids over 12 weeks. These findings support recommending saline therapy for up to 3 months before pursuing polysomnography, specialist referral, or surgical intervention.
Reference:
Nixon GM, Anderson D, Baker A, et al. Intranasal Treatments for Children With Sleep-Disordered Breathing: The MIST+ Randomized Clinical Trial. JAMA Pediatr. Published online January 20, 2026. doi:10.1001/jamapediatrics.2025.5717
