fluticasone-furoate and Sleep-Apnea--Obstructive

Continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea can produce troublesome nasal symptoms, especially congestion, which may affect the continuity of using CPAP. Intranasal steroids are often prescribed to reduce these side effects, although few recent studies exist supporting the benefits of this treatment for CPAP-induced nasal side effects.. Eighty-three patients with OSA were enrolled in a prospective, randomized controlled study. All patients received CPAP treatment and were divided in two groups. The study group was prescribed fluticasone furoate nasal spray 55 μg, and the compliance to CPAP for patients in both groups was recorded by device memory card. Total nasal symptom score was assessed using a questionnaire by direct interview, with follow-up performed at 30 and 90 days after treatment.. Compliance to CPAP increased in both groups with significantly greater compliance in the intranasal steroid group compared to the control group without intranasal steroid (P value = 0.002, 0.001, and 0.020, respectively) after 90 days of treatment. No difference in nasal symptoms was found between the groups after 30 days of treatment. However, adding an intranasal steroid resulted in decreased rhinorrhea and congestion symptoms (P value < 0.001 and < 0.001) after 90 days of treatment.. The addition of an intranasal steroid decreased the frequency of nasal symptoms, especially rhinorrhea and congestion, among patients with OSA initiating CPAP therapy and increased compliance to CPAP after 90 days of treatment.. IRB approval ID: R179h Clinical trial ID: TCTR20200715001.

Topics: Administration, Intranasal; Adult; Androstadienes; Continuous Positive Airway Pressure; Female; Humans; Male; Middle Aged; Nasal Sprays; Nose Diseases; Patient Compliance; Prospective Studies; Sleep Apnea, Obstructive; Surveys and Questionnaires

To determine the effect of intranasal corticosteroid therapy on T-regulatory cells and other inflammatory cytokines in adenoid tissues in children with obstructive sleep apnea syndrome.. Randomized, prospective, exploratory study.. Academic pediatric otolaryngology practice in a tertiary care children's hospital.. Participants included 24 children between the ages of 2 and 12 years who were undergoing adenotonsillectomy for polysomnogram-documented obstructive sleep apnea syndrome.. Children were randomized to either no treatment (n = 13) or treatment with fluticasone furoate nasal spray, 55 μg/nostril daily (n = 11), for 2 weeks before adenotonsillectomy. Adenoid tissue was obtained at the time of the procedure.. The number of tissue T-regulatory cells, as determined by staining with FOXP3, CD4, and CD25, was the primary outcome measure. Staining for interleukin (IL)-10 and transforming growth factor-β protein by immunohistochemistry, and adenoid mononuclear cell spontaneous and induced release of cytokines (IL-10, IL-6, IL-12, IL-13, tumor necrosis factor, and transforming growth factor β) were secondary outcomes.. Cells isolated from fluticasone furoate nasal spray-treated adenoid tissue released significantly less IL-6 spontaneously as well as upon stimulation with anti-CD3 monoclonal antibody (P = .05) compared with nontreated adenoid tissue. There were no significant differences in the number of CD4/FOXP3-, CD25/FOXP3-, or transforming growth factor β-positive cells. Intensity of staining for IL-10 was also comparable between the groups.. In this study, we show reduction of IL-6, a proinflammatory cytokine, in adenoid tissue obtained from children with obstructive sleep apnea syndrome treated with fluticasone furoate nasal spray. This reduction could contribute to the clinical efficacy of this class of medications in the treatment of childhood obstructive sleep apnea syndrome.

Topics: Adenoidectomy; Adenoids; Administration, Intranasal; Androstadienes; Child; Child, Preschool; Female; Glucocorticoids; Humans; Immunohistochemistry; Interleukins; Male; Prospective Studies; Sleep Apnea, Obstructive; Staining and Labeling; Tonsillectomy; Transforming Growth Factor beta; Tumor Necrosis Factors