Intranasal corticosteroid eases pediatric sleep apnea

Treatment with fluticasone furoate nasal spray reduces interleukin (IL)-6, a proinflammatory cytokine, in the adenoid tissues of children with obstructive sleep apnea syndrome, according to a study in the Archives of Otolaryngology-Head and Neck Surgery.

Researchers from the University of Chicago Medical Center conducted a randomized, prospective, exploratory study to examine how intranasal corticosteroid therapy affects T-regulatory cells and other inflammatory cytokines. They studied 24 children (aged 2 to 12 years) who were scheduled to have adenotonsillectomy for obstructive sleep apnea syndrome. Thirteen children received no treatment, and 11 received fluticasone nasal spray, 55 μg per nostril a day, for 14 days before surgery. Adenoid tissue was removed during surgery.

Primary outcomes included number of tissue T-regulatory cells, established by staining with FOXP3, CD4, and CD25. Secondary outcomes comprised staining for IL-10 and transforming growth factor-β protein by immunohistochemistry, as well as adenoid mononuclear cell spontaneous and induced release of cytokines (IL-6, IL-10, IL-12, and IL-13), tumor necrosis factor, and transforming growth factor β.

Cells that were isolated from the adenoid tissue released significantly less IL-6 in children who received fluticasone than in those who did not receive treatment. Fluticasone did not significantly affect the other cytokines. There were no major differences in the quantity of CD4/FOXP3-, CD25/FOXP3-, or transforming growth factor β-positive cells in treated or untreated children. Likewise, IL-10 staining was comparable in both groups of children.

“This reduction [of IL-6] could contribute to the clinical efficacy of this class of medications in the treatment of childhood obstructive sleep apnea syndrome,” say the researchers.

Despite the results, the researchers say there are limitations to their study. The sample size was small and treatment lasted only for 14 days. A higher dosage of fluticasone also might have had a greater effect.

Esteitie R, Emani J, Sharma S, Suskind DL, Baroody FM. Effect of fluticasone furoate on interleukin 6 secretion from adenoid tissues in children with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2011;137(6):576-582.