Children with mild obstructive sleep apnea may benefit from intranasal budesonide.
A six-week trial of intranasal budesonide in children with mild obstructive sleep apnea alleviated the severity of respiratory disturbance, and reduced the size of adenoid tissues. The steroid also slightly improved some components of sleep architecture. Plus, eight weeks after therapy, sleep or respiratory problems did not worsen.
Investigators in Louisville, Kentucky, recruited 62 children between 6 and 12 years of age who snored habitually and who had mild obstructive sleep apnea syndrome based on an initial overnight sleep study (polysomnographic assessment). They assigned these children to one of two groups: The treatment group started a six-week course of intranasal topical budesonide (32 mg per puff to each nostrils at bedtime), and the control group received once-a-day placebo spray. After six weeks, children underwent a second overnight sleep study and a lateral neck radiograph. Following a two-week washout period, participants then started a six-week course with placebo and study drug switched, and were evaluated again.
Compared with 32 children who received placebo in the first arm, the 48 youngsters who completed the treatment phase showed significant improvements in polysomnographic measures (sleep latency, slow-wave sleep, and rapid-eye-movement sleep), magnitude of respiratory disturbance, and in adenoid size. Moreover, obstructive apnea/hypopnea was normalized in children who received budesonide. The initial budesonide treatment effect was sustained in the children in the initial treatment arm who completed the second phase of the protocol, when they received placebo. Investigators noted that a child's age, overweight status, or having a history of allergy did not affect response to treatment (Kheirandish-Gozal L et al: Pediatrics 2008;122:e149).
It seems to me that this is worth a try. Nasal steroids are a non-invasive, relatively inexpensive therapy. Their use here might eliminate the need for tonsillectomy/ adenoidectomy and could substantially increase high-quality sleep, with all of its added benefits.
DR. BURKE, section editor for Journal Club, is chairman of the department of pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.