Intranasal Saline May Suffice for Some Kids' Sleep-Disordered Breathing

A study, led by Kirsten Perrett, PhD, of the Murdoch Children's Research Institute at Royal Children's Hospital in Melbourne, Australia, found that intranasal mometasone furoate was not more effective than saline in resolving symptoms of sleep-disordered breathing (SDB) in children.

The study, called MIST, randomized 276 patients ages 3 to 12 years with SDB to 6 weeks of daily intranasal treatment with either mometasone furoate (50 μg) or sodium chloride (0.9%). The primary outcome of the study was defined as a reduction of SDB symptoms to a level no longer requiring a specialist referral as per American Academy of Pediatrics (AAP) guidelines. After 6 weeks of treatment, the proportion of patients experiencing resolution of significant SDB symptoms was 44% and 41% with mometasone and saline, respectively.

In addition, the study found that recommendations for surgery decreased sharply in both groups from baseline (62-67%) to 6 weeks (32-38%). This suggests that either treatment, mometasone or saline, may reduce the need for specialty care or surgery. The study's authors suggested that primary care physicians may use 6 weeks of intranasal saline as a first-line treatment for children with SDB, as it is less invasive, cheaper, and readily available. This would improve the quality of life of children with SDB, reduce the burden on specialist services, and improve access to care for those who need it most. Furthermore, the authors noted that it is unclear whether the findings represent a treatment effect with mometasone furoate or saline or simply the natural history of the condition. Thus, they will be exploring this further in a study titled MIST+ study.

The authors also explained that current AAP guidelines recommend referring all children with SDB, including snoring, difficulty breathing, and other issues during sleep, for management. This may include polysomnography (PSG) or a specialist assessment, with prompt adenotonsillectomy (T&A) recommended for patients with moderate-severe obstructive sleep apnea (OSA). However, the current trial aimed to fill a gap in the management of children who may not have access to PSG, which is limited in many countries, where the decision to undergo T&A is made on history and clinical examination alone. They highlighted that T&A is painful, costly, and carries a risk of mortality and postoperative morbidity (hemorrhage and respiratory compromise). Also, they noted that evidence is lacking for the benefit of T&A in children with primary snoring without OSA.

Lastly, the study reported primary adverse events such as epistaxis (9.7% in the mometasone group and 15% in the saline group) and nasal itch or irritation (9.7% and 18% respectively). There were also some experimental limitations such as 26 patients were not present at the time of follow-up, and the ear, nose, and throat surgeons examined the patient's previous medical history and exams but did not provide a direct clinical assessment. Although there were limitations to the study, the researchers hope the findings from their research can be helpful in finding novel ways to treat SDB in children.

References:

Short, E. (2023, January 17). Intranasal Saline May Suffice for Some Kids' Sleep-Disordered Breathing. Medpage Today. Retrieved January 18, 2023, from https://www.medpagetoday.com/pulmonology/sleepdisorders/102669