CHEST Guidelines-Treatment-of-Intranasal-Corticosteroids-for-OSA-Sy

Treatment-of-Intranasal-Corticosteroids-for-OSA-Sy

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The editorial discusses the efficacy of intranasal corticosteroids (INCS) as a nonsurgical treatment for children with obstructive sleep apnea (OSA) syndrome. While adenotonsillectomy is the primary treatment for pediatric OSA, complications and parental preferences necessitate exploring alternatives like INCS. The treatment has been commonly used but lacks substantial evidence of its effectiveness.<br /><br />The editorial references a study by Tapia and colleagues, which aims to fill these gaps by conducting a large-scale, well-structured clinical trial with 134 children, aged 5 to 12 years, for an extended period. It involved a 12-week initial treatment and follow-up to 12 months, assessing various outcomes including changes in the obstructive apnea hypopnea index (OAHI) and parent-reported outcomes.<br /><br />Results from the initial 3-month period showed no significant difference in OAHI improvement between the INCS and placebo groups, with similar secondary outcomes. Even in longer treatment durations, improvements were modest and did not achieve normalization. However, the study observed fewer asthma exacerbations and upper respiratory infections in the INCS group, despite similar adverse event profiles between the groups.<br /><br />The editorial highlights a significant challenge in treatment adherence, noting only 57% of children adhered to daily therapy, dropping to 32% in the extended phase. This low adherence rate in the structured trial environment raises concerns about real-world application.<br /><br />Overall, while long-term INCS usage might contribute to some improvement in parent-reported symptoms and quality-of-life measures, short-term benefits are limited. The study underscores the need for developing noninvasive and acceptable treatments for pediatric SDB. Clinicians can use these insights to better advise parents on balancing treatment burdens with potential outcomes.

Keywords

intranasal corticosteroids

pediatric obstructive sleep apnea

adenotonsillectomy

clinical trial

obstructive apnea hypopnea index

treatment adherence

asthma exacerbations

upper respiratory infections

parent-reported outcomes

pediatric sleep-disordered breathing