Montelukast With or Without Intranasal Steroids Evaluated for Pediatric OSA

Montelukast is a leukotriene receptor antagonist
Montelukast is a leukotriene receptor antagonist

A meta-analysis of anti-inflammatory agents for the treatment of pediatric obstructive sleep apnea (OSA) found that montelukast plus intranasal steroids or montelukast alone may benefit patients with mild OSA. The findings were published in Otolaryngology - Head and Neck Surgery.

A team of authors performed a systematic review of studies examining anti-inflammatory treatments for pediatric OSA through June 28, 2018 using PubMed/MEDLINE and 4 other databases. Of the 135 studies screened, 32 were included for review and 6 met the inclusion criteria (N=688), which included pediatric patients aged 2 to 5 years. 

Results showed that montelukast as monotherapy for pediatric OSA (5 studies) resulted in a 55% improvement in apnea-hypopnea index (mean 6.2 events/hr pretreatment and 2.8 events/hr posttreatment; mean difference -2.7 events/hr, 95% CI, -5.6 to 0.3); lowest oxygen saturation (LSAT) improved from 89.5 to 92.1 (mean difference 2.2, 95% CI, 0.5-4.0). 

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Montelukast with intranasal steroids (2 studies) demonstrated a 70% improvement in apnea-hypopnea index (4.7 events/hr pretreatment and 1.4 events/hr posttreatment; mean difference -4.2 events/hr, 95% CI, -6.3, -2.0); LSAT improved from 87.8 to 92.6 (mean difference 4.8, 95% CI, 4.5-5.1). 

The authors were able to conclude that for mild pediatric OSA, treatment with montelukast +/- intranasal steroids may offer clinical benefit. 

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