Can Intranasal Corticosteroids Improve Obstructive Sleep Apnea Syndrome in Children?

Ignacio Tapia, MD

Treating children with obstructive sleep apnea syndrome (OSAS) often involves intranasal corticosteroids (INCS), however, the efficacy of this approach lacks rigorous testing to support it. A study featured at CHEST 2022, investigated the use of INCS in children to determine if the therapy improved OSAS symptoms, polysomnography findings, behavior, and quality of life compared with placebo.

According to Ignacio Tapia, MD, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, and the team of investigators who conducted the research, intranasal corticosteroids failed to demonstrate significant changes. Follow up with patients occurred at 3 and 12 months of treatment.

The double-blind, placebo-controlled trial randomized 134 children aged 5-12 years who were diagnosed with obstructive sleep apnea syndrome 2:1 to receive 3 months of INCS treatment or placebo. Following the 3 month assessment, those in the intervention group were re-randomized to either receive INCS for the following 9 months or placebo.

Measurements were recorded at baseline, 3 months and then finally at 12 months for the analysis. Investigators examined polysomnography, symptoms, and neurobehavioral findings to observe any change obstructive apnea hypopnea index (OAHI) after 3 months for the primary endpoint, available for 122 children. The secondary endpoint was OAHI change at 12 months, available for 70 children.

At baseline, the median age was 7.9 years and OAHI was 5.8 events per hour. Investigators observed no difference between the 2 study groups at 3 months or at 12 months. Additionally, no difference was identified when evaluating symptoms and neurobehavioral results at those intervals either.

However, the 38 children who received INCS for the full 12-month study duration exhibited a significant OAHI decrease. The median OAHI went from 7.2 events per hour at baseline to 3.7 events per hour at the final assessment.

"In children with OSAS, treatment with INCS did not result in significant polysomnography, neurobehavioral, or symptom changes at 3 and 12 months of treatment," the team concluded. "Twelve months of INCS treatment resulted in a statistically significant but not clinically relevant OAHI reduction."

The study "A Trial of Intranasal Corticosteroids to Treat Childhood OSA Syndrome" was published in CHEST Journal.