Intranasal corticosteroids yield no clinically meaningful improvement in paediatric OSAS

In the treatment of children with obstructive sleep apnoea syndrome (OSAS), use of intranasal corticosteroids falls short of producing substantial changes in symptoms as well as in polysomnographic and neurobehavioural parameters at 3 and 12 months, a study has found.

Furthermore, the 12-month obstructive apneoa hypopnea index (OAHI) significantly decreases from baseline with intranasal corticosteroids, although the difference is not clinically relevant as compared with placebo.

The study randomized 134 children with OSAS aged 5–12 years to 3 months of intranasal corticosteroids or placebo. Subsequently, children in the intranasal corticosteroids group were then rerandomized to 9 months of intranasal corticosteroids or placebo.

Researchers assessed polysomnography, symptoms, and neurobehavioral findings at baseline, 3, and 12 months. The primary outcome was obstructive OAHI change at 3 months, with data available for 122 children. OAHI change at 12 months, available for 70 children, was the secondary outcome.

The median age of the entire population was 7.9 years, and the median OAHI at baseline was 5.8/hour. The between-group difference in OAHI changes was –1.72/hour at 3 months and –1.2/hour at 12 months, both of which did not reach clinical significance.

OSAS symptoms and neurobehavioral results were also similar in the intranasal corticosteroids and placebo groups at 3 and 12 months.

Of note, the 38 children who received intranasal corticosteroids for 12 months achieved significant OAHI reduction, from 7.2/hour at baseline to 3.7/hour (p=0.039).