(1040) Topical Anti-Inflammatory Therapy and Surgical Avoidance in Pediatric Obstructive Sleep Apnea: A Systematic Review

Introduction: Medical therapies have been proposed as alternatives to surgery for mild pediatric obstructive sleep apnea (OSA). This review evaluates whether topical anti-inflammatory therapy reduces surgery rates in children with OSA.

Methods: A systematic review was conducted using PubMed to identify studies published from 1979 to present with 19 MeSH terms encompassing the following: OSA, sleep-disordered breathing (SDB), snoring, intranasal corticosteroids (ICS), tonsillectomy, and adenoidectomy. Patients ≤18 years with OSA or SDB receiving topical ICS at tertiary referral centers were included. The primary outcome was subsequent surgery. Studies involving systemic corticosteroids, other indications, or significant comorbidities were excluded. Meta-analysis was not performed due to clinical and methodological heterogeneity.

Results: Of 155 articles, two studies met inclusion criteria (retrospective n=836, prospective n=568). Populations included children 0.26-17.9 years with mild OSA (apnea-hypopnea index 1-5) or referral for SDB. Treatment ranged from 6 weeks to 15 months. In the longer treatment study, ~21% receiving ICS with montelukast proceeded to surgery versus ~86% without therapy. In the other, ~38% receiving ICS alone proceeded to surgery versus ~56% without therapy. Adherence was partially quantified in one study. Follow-up after topical therapy via OSA-5 or polysomnography was largely limited to the immediate post-treatment period.

Conclusions: Topical anti-inflammatory therapy may serve as an initial treatment option for children with mild OSA or SDB and may reduce the need for subsequent surgery, especially with longer treatment duration. Limited long-term follow-up after treatment precludes conclusions regarding sustained benefit or definitive surgical avoidance.