Montelukast possible surgery alternative for obstructive sleep apnea

By Lucy Piper, Senior medwireNews Reporter

Leukotriene modifiers may provide a noninvasive treatment option for children with nonsevere obstructive sleep apnea (OSA), say researchers.

They found that montelukast effectively reduced polysomnographic measures of sleep apnea, symptoms of disturbed sleep, and the size of adenoidal tissue in children with the sleep disorder.

"We are seeking a nonsurgical treatment that will be used instead of tonsillectomies and polypectomies in children, and as a replacement for continuous positive airway pressure machines for adults," lead researcher Aviv Goldbart (Ben Gurion University, Sheva, Israel) said in a press statement.

The team randomly assigned 46 children, aged 2 to 10 years, with nonsevere OSA (obstructive apnea/hypopnea index [AHI] <10) to receive daily oral montelukast, at 4 or 5 mg depending on whether younger or older than 6 years of age, respectively, or placebo.

Polysomnographic recordings taken after 12 weeks of montelukast treatment showed a significant 2.2-point reduction in the obstructive apnea index (OAI), from a pretreatment average of 3.9 to 1.7 after treatment. By contrast, the OAI remained unchanged in children given placebo.

Significant improvements were also seen for the AHI, the researchers note. "In fact, we recorded a >50% decrease in the AHI in 65.2% of treated children," they write in Pediatrics.

Other improvements in sleep symptoms following treatment included a reduction in breathing difficulties, snoring, sweating, and awakenings.

Montelukast treatment also reduced the size of the adenoids, with the adenoidal/nasopharyngeal ratio decreasing from 0.81 before treatment to 0.57 afterwards, whereas placebo had no effect.

"This anti-inflammatory approach has a clear effect in children with a nonsevere form of OSA," say Goldbart and team, who recommend offering the approach to parents as an option before, or instead of, surgery.

"However, it is important to acknowledge the need to follow up and switch to surgery when a child does not respond to anti-inflammatory therapy," they say.

In accordance with this, the researchers point out that as the children in their study were not obese and the main effect of montelukast was seen in the adenoids, "this approach is mainly advocated for children with enlarged adenoids, not children with obesity or with enlarged tonsils as the only symptom."

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