Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea

Brouillette, Robert T.; Manoukian, John J.; Ducharme, Francine M; Oudjhane, Kamaldine; Earle, Lois G.; Ladan, Sylvia; Morielli, Angela

doi:10.1067/mpd.2001.114474

Cited by 362 publications

(254 citation statements)

References 37 publications

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“…Sys- temic steroids were initially explored, but failed to yield any substantial benefits (40). In contrast, topical intranasal application of high-potency corticosteroids revealed significant improvements in AHI and oxygenation in a cohort of children with SDB (AHI Ͼ 5) (14). Unfortunately, this latter study did not examine the role of topical steroids in children with mild SDB (1 Ͻ AHI Ͻ 5), even if the expression pattern of glucocorticoid receptors suggests a favorable therapeutic profile for adenotonsillar tissue in children with SDB (41).…”

Section: Definition Of Abbreviationsmentioning

confidence: 99%

“…Nonsurgical antiinflammatory approaches have been cautiously advocated for SA in children (14,15). Indeed, nasal and oropharyngeal mucosal inflammation are present in adult patients with obstructive sleep apnea syndrome (16)(17)(18)(19), and C-reactive protein, a systemic marker for inflammation, was recently reported to be increased in the serum of children with SA, and to correlate with the severity of their respiratory disturbance during sleep (20).…”

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confidence: 99%

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Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

Goldbart

Goldman

Veling

et al. 2005

Am J Respir Crit Care Med

283

157

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Background: Children with mild sleep-disordered breathing (SDB), who may not be recommended for adenotonsillectomy, frequently exhibit neurocognitive and behavioral morbidity, and may benefit from alternative therapeutic interventions, such as leukotriene modifier therapy. Methods: Twenty-four children with SDB completed an open-label intervention study for 16 weeks with daily montelukast therapy. Sleep studies and adenoid size estimates from lateral X-ray films of the neck were obtained before and after treatment. In a parallel study, adenoid and tonsillar tissues from children with obstructive sleep apnea or recurrent throat infections were subjected to quantitative polymerase chain reaction, immunohistochemistry, and Western blotting for gene and protein expression of leukotriene receptors LT1-R and LT2-R, and for concentrations of LTB4 and LTC4/D4/E4. Results: Montelukast treatment induced significant reductions in adenoid size and respiratory-related sleep disturbances, which were absent in 16 children with SDB who did not receive treatment. LT1-R and LT2-R mRNA was similarly abundant in adenoid tissues, but increased LT1-R and LT2-R protein expression and higher levels of LTB4 and LTC4/D4/E4 emerged in children with obstructive sleep apnea. Conclusions: Oral therapy with a leukotriene modifier appears to be associated with improved breathing during sleep. Double-blind, placebo-controlled trials will be needed to corroborate current findings and solidly establish antiinflammatory strategies, such as leukotriene modifiers, as therapeutic alternatives in children with SDB too mild to justify referral for adenotonsillectomy.

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Section: Definition Of Abbreviationsmentioning

confidence: 99%

mentioning

confidence: 99%

Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

Goldbart

Goldman

Veling

et al. 2005

Am J Respir Crit Care Med

283

157

View full text Add to dashboard Cite

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“…Patients who refused surgery or in whom surgical intervention was not indicated by pre-determined criteria (small tonsils; tonsils not extend beyond the anterior tonsillar pillar and small adenoids; adenoids which occupy less than 25% of post-nasal space with minimal OSAS symptoms or poorly controlled allergic rhinitis with supine nasal obstruction) were offered alternative treatment options including nocturnal non-invasive positive pressure ventilation (NIPPV) and/or nasal corticosteroids therapy. 29 All subjects underwent repeat assessment 8 weeks after the operation or commencement of NIPPV. Patients prescribed nasal corticosteroids had repeat assessment performed after 3 months.…”

Section: Treatment and Follow-upmentioning

confidence: 99%

C‐reactive protein in children with obstructive sleep apnea and the effects of treatment

Chan

Yin

et al. 2007

Pediatric Pulmonology

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Summary. Objective To evaluate C-reactive protein (CRP) concentration in children with OSA and to determine the effects of treatment for OSA on its serum concentration. Methods Consecutive children with habitual snoring and symptoms suggestive of OSA were recruited. They completed a sleep apnea symptom questionnaire, underwent physical examination and an overnight polysomnography (PSG). Fasting serum CRP and lipid profile were taken after overnight PSG. OSA was diagnosed if obstructive apnea index (OAI) > 1. Results One hundred forty-one children with a median (IQR) age of 10.8 (8.5-12.8) years were recruited. There were 96 boys and the commonest presenting symptoms were nocturnal mouth breathing, prone sleeping position and poor attention at school. Forty-five children were found to have OSA and those with moderate disease (OAI > 5) had significantly higher CRP levels compared to their non-OSA counterparts

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“…Small studies evaluating the effects of anti-inflammatory therapies in children with OSA have been reported for longer than a decade. There is some evidence that nasal steroids may reduce AHI (though in an early study, not adenotonsillar size) [40] as well as symptoms, in children with mild sleep-disordered breathing [41]. The clinical effect has been reported to be maintained for several months after treatment.…”

Section: Sleep Disordered Breathingmentioning

confidence: 99%

Current Treatment of Selected Pediatric Sleep Disorders

Sullivan

2012

Neurotherapeutics

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While pediatric sleep disorders are relatively common, treatments are often not straightforward. There is often a paucity of gold standard studies and data available to guide clinicians, treatments may yield arguably incomplete results, interventions may require chronic use, and/ or involve multiple modalities including behavioral interventions that require high parental and family commitment. This review points out diagnostic differences compared to adults and focuses on current therapy for selected common pediatric sleep disorders including sleep disordered breathing/ obstructive sleep apnea, narcolepsy, and restless legs syndrome. Other common pediatric sleep disorders, such as insomnia and parasomnias, are not covered.

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Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea

Cited by 362 publications

References 37 publications

Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

C‐reactive protein in children with obstructive sleep apnea and the effects of treatment

Current Treatment of Selected Pediatric Sleep Disorders

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