Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-blind Randomized Placebo-controlled Trial

Kheirandish‐Gozal, Leila; Bandla, Hari; Gozal, David

doi:10.1513/annalsats.201606-432oc

Cited by 70 publications

(89 citation statements)

References 35 publications

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“…Trials of bilevel positive airway pressure, autotitrating positive airway pressure, and comfort features, such as pressure relief during exhalation, all demonstrate efficacy but adherence remains poor. 6 alternatives include medical management with nasal steroid sprays and leukotriene antagonists [14][15][16] and positional therapies such as wedges that limit supine sleep, which are generally effective at reducing the severity of, but not resolving, OSA.…”

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confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

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confidence: 99%

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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“…Goldbart et al 6 showed significant improvement in the obstructive apnea index (3.9 ± 1.6 events/h before vs. 1.7 ± 1.0 events/h after treatment) and a decrease in A/N ratio (0.81 ± 0.004 before vs. 0.57 ± 0.004 after treatment) after 12 w of montelukast therapy. In another placebo-controlled trial, 7 AHI was reduced from 9.2 to 4.2 after 16 w of montelukast therapy in children age 2 to 10 y. To our knowledge, the efficacy of montelukast in the treatment of severe OSA in children has not been documented.…”

Section: Discussionmentioning

confidence: 90%

“…Oral montelukast has been used in children with mild to moderate OSA. Previous clinical studies, [4][5][6][7] including double-blind and placebo-controlled trials, have shown that treatment with montelukast significantly reduced adenoid size and reduced respiratory-related sleep disturbances in children with mild to moderate OSA. An open study 4 reported that obstructive apnea index was reduced from 3.0 to 2.0 and the A/N ratio was decreased from 0.76 to 0.56 after 16 w of montelukast therapy.…”

Section: Discussionmentioning

confidence: 99%

A Four-Year-Old Boy with Unusually Severe Obstructive Sleep Apnea

Zhou

Yang

et al. 2017

Journal of Clinical Sleep Medicine

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frequent and very severe reductions in blood oxygen saturation (SpO 2 , lowest at 55%). Persistent, large-range variations in heart rate (70-140 beats/min) were associated with frequent OSA events and occurred throughout the night. The radiograph showed nasopharyngeal stenosis with tonsil and adenoid hypertrophy (adenoidal nasopharyngeal ratio (A/N): 0.92; normal range < 0.5-0.6).The patient's parents did not want to consider surgery and preferred medication as a first treatment. Therefore, montelukast (oral, 5 mg/day) was prescribed. After taking montelukast for 2 mo, the patient's frequency and severity of snoring was reduced. Repeat polysomnogram showed a surprising reduction in the AHI to 2.4 events/h during a total sleep time of 8.19 h (supine position 34%, REM 19.4%). Overnight measurements of SpO 2 and heart rate stabilized to nearly normal levels ( Figure 1B). The nasopharyngeal airway also appeared wider in the radiograph (A/N: reduced from 0.92 to 0.80).A 4-y-old boy presented with frequent snoring and mouth breathing, but no other symptoms often seen in children with obstructive sleep apnea (OSA) (e.g., observed episodes of apnea, daytime sleepiness, enuresis, and hyperactivity). His mother stated that the frequency and severity of his snoring varied from time to time. He did not frequently have colds, estimated at once or twice a year. He had normal physical and mental development (height 110 cm, body weight 19 kg, body mass index 15.7 kg/m 2 ). He appeared to have a mild adenoid face (a slightly short upper lip with mandibular hypoplasia) and obvious tonsillar hypertrophy (grade 3+ tonsils with < 75% of space between pillars) and a stage II Friedman classification.The patient underwent overnight polysomnography, and a radiograph of the lateral neck was obtained. Surprisingly, we found that the patient had unusually severe OSA based on the apnea-hypopnea index (AHI), which was as high at 102.5 events/h. During a recorded total sleep time of 7.75 h (supine position 64%, rapid eye movement (REM) sleep 25.1%), he had 713 obstructive apnea events (longest at 53 sec), 73 hypopnea events (longest at 55 sec) and 8 mixed apnea events (longest at 31 sec) but no central sleep apnea events. As demonstrated in Figure 1A, the patient experienced SLEEP MEDICINE PEARLS

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“… Chan 2015 and Kheirandish‐Gozal 2016 reported oxyhaemoglobin desaturation (≥3%) index (ODI3). Brouillette 2001 reported oxyhaemoglobin desaturation (≥4%) index (ODI4).…”

Section: Resultsmentioning

confidence: 99%

Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

Lin

et al. 2019

Int J Paed Dentistry

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Background Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. Aim Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta‐analysis. Design Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea‐hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2). Frequentist approach to network meta‐analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Results Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta‐analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2. No comparisons showed statistical significance in reducing ODI. Conclusions Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.

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Montelukast for Children with Obstructive Sleep Apnea: Results of a Double-blind Randomized Placebo-controlled Trial

Cited by 70 publications

References 35 publications

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

A Four-Year-Old Boy with Unusually Severe Obstructive Sleep Apnea

Management of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis

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