Childhood Obstructive Sleep Apnea and Anti-Inflammatory Treatment


David Gozal, MD The Herbert T. Abelson Professor and Chair Department of Pediatrics Physician-in-Chief, Comer Children's Hospital The University of Chicago Chicago, IL Interview with:
David Gozal, MD
The Herbert T. Abelson Professor and Chair
Department of Pediatrics
Physician-in-Chief, Comer Children’s Hospital
The University of Chicago  Chicago, IL 60637 What are the main findings of the study?

Dr. Gozal: Our study shows that in children with mild obstructive apnea, treatment with an anti-inflammatory combination of 2 medications, namely nasal corticosteroid and oral montelukast is associated with favorable outcomes in the vast majority of the children. Thus, rather than pursue treatment with adenotonsillectomy as is currently the case in most places, this study paves the way for non-surgical alternative therapies in pediatric OSA. Were any of the findings unexpected?

Dr. Gozal: Although we anticipated that a certain proportion of children with mild OSA would not respond to the treatment,  our study informed us that obese children and older children are less likely to benefit from this non-surgical approach. These findings may therefore require implementation of a different set of diagnostic and treatment algorithm criteria that includes age and BMI z score  as determinants of success probability for the non-surgical treatment of OSA in children. What should clinicians and patients take away from your report?

Dr. Gozal: That real life experience with a nasal corticosteroid and oral montelukast in the management of children with mild OSA appears to justify their use in clinical practice, rather than proceed immediately to surgical adenotonsillectomy. However, we should caution all clinicians that  although our study included a large number of patients, it was retrospective in nature and based on a single center experience, such that randomized clinical trials will be needed to validate this approach. What recommendations do you have for future research as a result of this study?

Dr. Gozal: The ultimate kernel of evidence-based clinical practice currently relies on multicenter randomized double blind clinical trials. The cumulative evidence on the use of anti-inflammatory therapy approaches is currently robust enough to justify the implementation of this type of clinical trial and thus provide a firm scientific foundation for the use of such treatment in children with OSA.

Anti-Inflammatory Therapy Outcomes for Mild OSA in Children

Kheirandish-Gozal L, et al “Anti-Inflammatory Therapy Outcomes for Mild OSA in Children” Chest 2014.

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Physician in practice over 30 years. Editor of All interviews conducted exclusively for by Marie Benz, MD.