Urinary cysteinyl leukotriene E4 level and therapeutic response to montelukast in children with mild obstructive sleep apnea

Sunkonkit, Kanokkarn; Sritippayawan, Suchada; Veeravikrom, Montida; Deerojanawong, Jitladda; Prapphal, Nuanchan

doi:10.12932/ap0879

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…Overall, measurement of uLTE 4 is a sensitive and noninvasive method of assaying total body production of CysLTs and is a useful biomarker of exposure to atopic and nonatopic asthma triggers [47,167], recent asthma exacerbations [168], AERD [166,169], early development of childhood atopy [170,171], and obstructive sleep apnea [172,173]; it is also useful for predicting susceptibility to LT receptor antagonists [174,175,176].…”

Section: Urinary Lte4 As a Biomarker Of Allergic Diseasementioning

confidence: 99%

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

Jo-Watanabe

Okuno

Yokomizo

2019

IJMS

115

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Leukotrienes (LTs) are lipid mediators that play pivotal roles in acute and chronic inflammation and allergic diseases. They exert their biological effects by binding to specific G-protein-coupled receptors. Each LT receptor subtype exhibits unique functions and expression patterns. LTs play roles in various allergic diseases, including asthma (neutrophilic asthma and aspirin-sensitive asthma), allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and anaphylaxis. This review summarizes the biology of LTs and their receptors, recent developments in the area of anti-LT strategies (in settings such as ongoing clinical studies), and prospects for future therapeutic applications.

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Section: Urinary Lte4 As a Biomarker Of Allergic Diseasementioning

confidence: 99%

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

Jo-Watanabe

Okuno

Yokomizo

2019

IJMS

115

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“…Baseline tonsillar hypertrophy and weight gain are predictors of disease progression. 41 In the management of this category of childhood OSA, parents may therefore opt for less invasive intervention such as nasal corticosteroids, 43 leukotriene receptor antagonist 44 and myofunctional therapy. 45 More non-surgical interventional studies for mild childhood OSA are needed.…”

Section: Discussionmentioning

confidence: 99%

Effect of surgical intervention for mild childhood obstructive sleep apnoea on attention and behavioural outcomes: A randomized controlled study

Chan

Lee

et al. 2021

Respirology

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Background and objective: We evaluated inattention and behavioural outcomes following surgery versus watchful waiting (WW) in school-aged children with mild obstructive sleep apnoea (OSA). Methods: A prospective randomized controlled study was performed in pre-pubertal children aged 6-11 years with polysomnography (PSG)-confirmed mild OSA. They were assigned randomly to early surgical intervention (ES) or WW. The surgical intervention consisting of tonsillectomy with or without adenoidectomy and turbinate reduction was carried out within 4-6 weeks after randomization. Both groups underwent PSG, attention and behavioural assessment and review by an otorhinolaryngologist at baseline and 9-month follow-up. The primary outcome was omission T score from Conners' continuous performance test (CPT). Secondary outcomes were parentreported behaviours, quality of life, symptoms and PSG parameters. Results: A total of 114 participants were randomized. Data of 35 subjects from the ES and 36 from the WW group were available for final analysis. No significant treatment effect could be found in all CPT parameters and behavioural outcomes. Nevertheless, significantly greater reductions were seen in PSG parameters (obstructive apnoeahypopnoea index [−1.4 AE 2.0 cf. +0.3 AE 4.1/h, p = 0.038] and arousal index [−1.3 AE 4.4 cf. +1.4 AE 4.5/h, p = 0.013]) and OSA-18 total symptom score (−17.3 AE 19.7 cf. −3.6 AE 14.1, p = 0.001) in the ES group. Subjects who underwent surgery also had significantly greater weight gain (+3.3 AE 2.1 cf. +2.2 AE 1.5 kg, p = 0.014) and increase in systolic blood pressure (+5.1 AE 12.4 cf. −1.2 AE 8.7 mm Hg, p = 0.016). Conclusion: Despite improvements in PSG parameters and parent-reported symptoms, surgical treatment did not lead to parallel improvements in objective attention measures in school-aged children with mild OSA.

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“…Urinary cysteinyl leukotrienes (cysLTs) can be used as predictors of the efficacy of montelukast. Several studies demonstrated the positive correlation between OSA severity and cysLT levels [64,66]. Sunkonkit et al reported higher urinary cysLT levels in subjects who responded to montelukast therapy compared to non-responders [66].…”

Section: Leukotriene Receptor Antagonists (Ltra)mentioning

confidence: 99%

“…Several studies demonstrated the positive correlation between OSA severity and cysLT levels [64,66]. Sunkonkit et al reported higher urinary cysLT levels in subjects who responded to montelukast therapy compared to non-responders [66]. Although there are no precise reference values, the authors found that the values of urinary cysLTs E4 (the major urinary metabolite of cysLTs) >1.457 pg/mg creatinine could have a very high specificity and sensitivity in predicting the therapeutic response to montelukast [64].…”

Section: Leukotriene Receptor Antagonists (Ltra)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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Urinary cysteinyl leukotriene E4 level and therapeutic response to montelukast in children with mild obstructive sleep apnea

Abstract: We found the association between ULTE4 and therapeutic response to monteleukast. The uLTE₄ level of ≥ 1,457 pg/mg creatinine could predict the therapeutic response to montelukast in children who had ATH and mild OSA.

Cited by 7 publications

References 15 publications

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

The Role of Leukotrienes as Potential Therapeutic Targets in Allergic Disorders

Effect of surgical intervention for mild childhood obstructive sleep apnoea on attention and behavioural outcomes: A randomized controlled study

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

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