pulmicort and Sleep-Apnea--Obstructive

This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.. PubMed, Embase and Cochrane Library were searched from the inception of each database to November 2015. Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study. Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children.. A total of seven RCTs were finally incorporated into our network meta-analysis. Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate, montelukast, budesonide and fluticasone concerning apnea hypopnea index (AHI) value [WMD=1.40, 95% confidence interval (CI)=1.17-1.63; WMD=2.80, 95% CI=1.01-4.59; WMD=3.50, 95% CI=3.34-3.66; WMD=7.20, 95% CI=5.26-9.14, respectively], and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50, 95% CI=2.42-4.58); regarding visual analogue scale, the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94, 95% CI=1.13-2.75; WMD=1.06, 95% CI=0.22-1.90), and sucralfate is better than clindamycin (WMD=-0.88, 95% CI=-1.65 to -0.11). However, network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency. Furthermore, the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment.. Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children, thus providing an important guiding significance for the treatment of OSAHS in children.

Topics: Acetates; Bayes Theorem; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Cyclopropanes; Female; Fluticasone; Humans; Male; Prognosis; Quinolines; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Sleep Apnea, Obstructive; Sulfides; Treatment Outcome

Although the question of whether early diagnosis and treatment of pediatric allergic rhinitis (AR) improve disease control is important, a more crucial question is whether we can evaluate the effect of treatment on disease control using an impairment-risk model.. To conduct a systematic review evaluating application of a control model based on domains of impairment and risk (similar to that used for asthma) in pharmacotherapy for children with AR.. We searched the MEDLINE and EMBASE databases (January 1, 1996, through May 31, 2012) for controlled studies lasting 2 weeks or longer in children with confirmed diagnoses of AR, including measures assessing impairment and/or risk of comorbid conditions.. Sixteen controlled clinical trials, including more than 3000 children (aged 2-18 years) with AR (seasonal, n = 2290; perennial, n = 800), met the study criteria. All medication classes improved impairment related to AR, but between-treatment comparisons were limited because of different assessments. Intranasal steroids improved risk outcomes associated with asthma and obstructive sleep apnea. Small single studies suggested possible effects of oral antihistamines on asthma and sleep-disordered breathing. No risk data were available for nasal antihistamines or montelukast sodium.. Treatment of AR, particularly with intranasal steroids, improves disease control in children by reducing disease-associated impairment and risk. All AR medications with proved efficacy probably improve impairment, paralleling symptom reduction. Intranasal steroids may reduce the likelihood of comorbidities that increase health care use. These observations, although limited by different protocols and outcomes measures among studies, support current practice recommendations. Studies that use standardized measures of impairment to permit better comparison and appropriate protocols for risk evaluation are needed.

Topics: Budesonide; Child; Comorbidity; Early Diagnosis; Glucocorticoids; Health Status Indicators; Humans; Quality of Life; Rhinitis, Allergic, Perennial; Sleep Apnea, Obstructive; Surveys and Questionnaires

The obstructive sleep apnea syndrome is common and its prevalence is expected to increase with the current obesity epidemic. If left untreated, it is associated with important morbidity such as growth failure, neurocognitive impairment, systemic and pulmonary hypertension, and endothelial dysfunction. Recent research has shown that many children, especially the obese or those with other underlying medical conditions, have residual obstructive sleep apnea after adenotonsillectomy (the primary treatment for childhood obstructive sleep apnea). These children could be effectively treated with continuous positive airway pressure but poor adherence is a significant limitation of this therapy. Therefore, new treatment modalities for the pediatric obstructive sleep apnea syndrome are needed. Current research has focused on newer therapies for pediatric obstructive sleep apnea, such as anti-inflammatories, dental treatments, high-flow nasal cannula, and weight loss. However, there are few randomized controlled trials assessing the effectiveness of these therapies. Further research is warranted.

Topics: Anti-Inflammatory Agents; Budesonide; Child; Humans; Insufflation; Orthodontic Appliance Design; Orthodontic Appliances; Prednisone; Prone Position; Respiratory Therapy; Sleep Apnea, Obstructive; Supine Position; Therapeutics; Weight Loss

Obstructive sleep apnea (OSA) is characterized by partial or complete upper airway obstruction during sleep. Approximately 1% to 4% of children are affected by OSA, with adenotonsillar hypertrophy the most common underlying risk factor. Surgical removal of enlarged tonsils and adenoids is the most commonly used treatment for OSA. Given the perioperative risk of the intervention and an estimated recurrence rate of up to 20%, there has recently been an increased interest in non-surgical treatment modalities. As the enlarged adenoids and tonsils consist of hypertrophied lymphoid tissue, anti-inflammatory agents have been proposed as a useful non-invasive treatment option in children with OSA.. To assess the efficacy of anti-inflammatory drugs for the treatment of OSA in children.. We identified trials using searches of the Cochrane Airways Group Specialized Register, MEDLINE (1950 to 2010), EMBASE (1988 to 2010), CINAHL (1982 to 2010), CENTRAL (1964 to 2010), Web of Science (1900 to 2010), LILACS (1982 to 2010) and International Pharmaceutical Abstracts (IPA) (1970 to 2010).. Randomized controlled trials (RCTs) comparing anti-inflammatory drugs against placebo, other anti-inflammatory drugs, or other treatment in children between one and 16 years with objectively diagnosed OSA (Apnea Hypopnea Index (AHI) ≥ 1/hour (h)).. Both authors independently performed data extraction and quality assessment. It was not possible to combine data from the included studies; we summarized data in a narrative fashion.. We included three RCTs. The first study was a six-week parallel-group trial (25 participants, mean age 3.8 years, mean AHI 10.8/h) of intranasal fluticasone versus placebo showed a statistically significant effect of the drug on improving the AHI. The second study compared intranasal budesonide with placebo in a six-week cross-over trial (62 participants, mean age 8.2 years, mean AHI 3.7/h). The authors reported an advantage of the drug over placebo in reducing the AHI. However, the patients were not analyzed as randomized so the result must be interpreted with caution. No valid group comparisons were reported for the third trial (30 participants, oral montelukast versus placebo in a 12-week parallel-group trial), which has so far only been published as an abstract.. A single small study has found a short-term beneficial effect on the AHI in children with mild to moderate OSA. However, long-term safety and efficacy data are not available yet. Further RCTs are needed to evaluate anti-inflammatory drugs for OSA in children.

Topics: Acetates; Administration, Intranasal; Administration, Oral; Androstadienes; Anti-Inflammatory Agents; Budesonide; Child; Child, Preschool; Cyclopropanes; Fluticasone; Humans; Quinolines; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Sulfides

Intranasal corticosteroids have been advanced as a nonsurgical therapeutic alternative for pediatric obstructive sleep apnea syndrome, particularly for patients with mild disease, and aims at reducing the size of hypertrophic adenotonsillar tissue.. Of 71 possible candidates, 62 children with polysomnographically diagnosed mild obstructive sleep apnea syndrome were recruited onto a double-blind, randomized, crossover trial of intranasal budesonide (32 microg per nostril at bedtime) or placebo for 6 weeks followed by an additional 6-week treatment in the alternative treatment arm after allowing for a 2-week washout period. Polysomnographic assessment and radiographs for assessment of adenoid size were performed after completion of each phase.. There were significant improvements in both polysomnographic measures (sleep latency, slow-wave sleep, and rapid-eye-movement sleep), in the magnitude of respiratory disturbance (apnea/hypopnea index, nadir pulse oxygen saturation), and in adenoid size among the 48 children who completed the treatment phase compared with 32 children who received placebo in their initial arm, with normalization of sleep measures in 54.1% of the treated children. Furthermore, discontinuation of treatment for 8 weeks for 25 children revealed a sustained duration of the initial treatment effect.. A 6-week treatment with intranasal budesonide effectively reduced the severity of mild obstructive sleep apnea syndrome and the magnitude of the underlying adenoidal hypertrophy, and this effect persisted for at least 8 weeks after cessation of therapy. These findings justify the use of topical steroids as the initial therapeutic option in otherwise healthy children with mild obstructive sleep apnea.

Topics: Adenoids; Administration, Intranasal; Budesonide; Child; Child, Preschool; Cross-Over Studies; Double-Blind Method; Female; Glucocorticoids; Humans; Hypertrophy; Infant; Male; Polysomnography; Sleep Apnea, Obstructive; Treatment Outcome

Nasal corticosteroids improve polysomnography indices but not symptoms in children with mild to moderate sleep-disordered breathing. We hypothesized that administration of nasal corticosteroids for 4 weeks to snoring children with only mild elevation in their apnea-hypopnea index would improve both polysomnography findings and symptoms of sleep-disordered breathing. Budesonide 50 mcg per nostril twice daily was administered for 4 weeks to children (2-14 years old) with habitual snoring and an apnea-hypopnea index of 1-10 episodes/hr. Subjects were evaluated before treatment and at 2 weeks and 9 months after its completion. Primary outcome variables were changes in apnea-hypopnea index and symptom score. Twenty-seven children were studied. At 2 weeks, the mean apnea-hypopnea index decreased from 5.2 (+/-2.2) episodes/hr to 3.2 (+/-1.5) episodes/hr, and median oxygen desaturation of hemoglobin index fell from 3.1 (0.4-8.2) to 1.9 (0.2-5.4) (P < 0.0001). Mean symptom score was 1.33 (+/-2.11) at baseline, and decreased to -0.008 (+/-2.24) at 2 weeks after treatment and to -1.08 (+/-1.75) at 9 months after treatment (P < 0.05). Four weeks of nasal budesonide improved both polysomnography findings and symptoms in children with mild sleep-disordered breathing. The clinical effect is maintained for several months after treatment.

Topics: Administration, Intranasal; Adolescent; Adrenal Cortex Hormones; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Patient Selection; Polysomnography; Sleep Apnea, Obstructive; Snoring