Effects of intranasal steroids on continuous positive airway pressure compliance among patients with obstructive sleep apnea

Segsarnviriya, Charnsiri; Chumthong, Rutti; Mahakit, Prasit

doi:10.1007/s11325-020-02236-5

Cited by 11 publications

(4 citation statements)

References 26 publications

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“… 104 A more recent study showing additional INS treatment decreased the frequency of nasal symptoms among patients with OSAS initiating CPAP therapy and increased compliance to CPAP after 90 days of treatment. 105 No similar studies were found in paediatric patients.…”

Section: Treatment Optionsmentioning

confidence: 95%

Paediatrics: how to manage obstructive sleep apnoea syndrome

Leung¹,

Cheng²,

Chan³

2021

DIC

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Obstructive sleep apnoea syndrome (OSAS) is defined as the intermittent reduction or cessation of airflow due to partial or complete obstruction of the upper airway during sleep. Paediatric OSAS has specific contributing factors, presenting symptoms and management strategies in various age groups. Untreated OSAS can lead to detrimental effects on neurocognitive development and cardiovascular and metabolic functions of a growing child. In the past decade, practice guidelines have been developed to guide the evaluation and management of OSAS. This article provides a narrative review on the current diagnostic and treatment options for paediatric OSAS. Alternative diagnostic tools other than the standard polysomnography are discussed. Adenotonsillectomy is considered the first-line therapy yet it is not suitable for treatment of all OSAS cases. Nocturnal non-invasive positive airway pressure ventilation is effective and could be the priority treatment for patients with complex comorbidities, residual OSAS post-adenotonsillectomy or obesity. However, intolerance and non-adherence are major challenges of positive airway pressure therapy especially in young children. There is increasing evidence for watchful waiting and other gentler alternative treatment options in mild OSAS. The role of anti-inflammatory drugs as the primary or adjunctive treatment is discussed. Other treatment options, including weight reduction, orthodontic procedures and myofunctional therapy, are indicated for selected patients. Nevertheless, the successful management of paediatric OSAS often requires a multidisciplinary team approach.

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Section: Treatment Optionsmentioning

confidence: 95%

Paediatrics: how to manage obstructive sleep apnoea syndrome

Leung¹,

Cheng²,

Chan³

2021

DIC

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“…However, intranasal steroids (INS) are commonly administered to decrease nasal congestion and rhinorrhea, the most common side effects of CPAP. They are, therefore, useful in patients with low CPAP adherence due to rhinitis [39] and in adult patients they seem to increase compliance to ventilation after 90 days of treatment [40].…”

Section: Continuous Positive Airway Pressure (Cpap)mentioning

confidence: 99%

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

Mussi,

Forestiero,

Zambelli

et al. 2023

JCM

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Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/− montelukast, and to compare the impact of standardized approaches for weight loss.

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“…Intranasal steroid sprays and antihistamine sprays are effective in reducing mucosal edema and improving nasal congestion [24]. When compared to a control, topical nasal steroid use can also significantly improved 90-day PAP compliance in OSA patients with pretreatment nasal congestion [25]. However, there is sparse data on if topical medications can improve daytime sleepiness or objective metrics on polysomnography.…”

Section: Key Pointsmentioning

confidence: 99%

Obstructive sleep apnea for the rhinologist

Nogues,

Jain,

Chou

et al. 2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose Obstructive sleep apnea (OSA) is a ubiquitous disease defined by repetitive partial or complete cessation of airflow during sleep caused by upper airway collapse. Otolaryngologists play a crucial role in the management of OSA, which is rapidly evolving with the advent of new surgical techniques and medical devices. Here we review the medical and surgical treatment options for OSA with a focus on unique considerations for patients with OSA who undergo nasal, sinus, and skull base surgery. Recent findings Treatment of OSA includes both nonsurgical and surgical options. Positive airway pressure (PAP) therapy remains the first-line medical treatment for OSA, but alternatives such as oral appliance and positional therapy are viable alternatives. Surgical treatments include pharyngeal and tongue base surgery, hypoglossal nerve stimulation therapy, and skeletal surgery. Nasal surgery has been shown to improve sleep quality and continuous positive airway pressure (CPAP) tolerance and usage. Sinus and skull base patients with comorbid OSA have special perioperative considerations for the rhinologist to consider such as the need for overnight observation and timing of CPAP therapy resumption. Summary OSA patients present with special considerations for the rhinologist. Patients with moderate to severe OSA may benefit from overnight observation after ambulatory surgery, especially those with an elevated BMI, cardiopulmonary comorbidities, and those who are not using CPAP regularly at home. Though CPAP may be safely resumed in the perioperative setting of nasal, sinus, and skull base surgery, the exact timing depends on patient, surgeon, and systemic factors such as severity of OSA, CPAP pressures required, extent of surgery, and the postoperative monitoring setting. Lastly, nasal and sinus surgery can improve sleep quality and CPAP tolerance and compliance in patients with OSA.

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Effects of intranasal steroids on continuous positive airway pressure compliance among patients with obstructive sleep apnea

Cited by 11 publications

References 26 publications

Paediatrics: how to manage obstructive sleep apnoea syndrome

Paediatrics: how to manage obstructive sleep apnoea syndrome

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

Obstructive sleep apnea for the rhinologist

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