Study Shows Saline Nasal Spray Effectively Treats Sleep-Disordered Breathing in Children

Researchers from Monash Children's Hospital and Royal Children's Hospital Melbourne have found that a daily intranasal saline spray resolved symptoms of obstructive sleep-disordered breathing (OSDB) in nearly one-third of children over a six-week period. The addition of an intranasal steroid did not provide further benefits for children whose symptoms persisted.

Obstructive sleep-disordered breathing is prevalent in childhood, affecting up to 12% of children and associated with significant comorbid conditions. Adenotonsillectomy is the standard treatment for pediatric OSDB, often resulting in improvements in sleep quality, behavior, and overall health, but it carries surgical risks, prompting interest in non-invasive treatments.

Previous studies indicated that intranasal steroids can improve OSDB severity over six to 16 weeks. However, a larger randomized trial suggested comparable symptom improvements between intranasal saline and steroid treatments after six weeks, indicating that saline may not simply act as a placebo.

The study, titled "Intranasal Treatments for Children With Sleep-Disordered Breathing," was published in JAMA Pediatrics. In this double-blind, placebo-controlled trial, 139 children aged 3 to 12 participated in six weeks of saline treatment, with 41 children (29.5%) experiencing symptom resolution. Among the 93 children with ongoing symptoms at six weeks, 47 received intranasal mometasone furoate, while 46 continued with saline.

Family perceptions regarding surgical intervention changed during the saline treatment; the belief that a child required surgery decreased from 64.5% at enrollment to 56.3% at six weeks. Willingness to proceed with surgery dropped from 91.1% at enrollment to 87.6% at week six.

In a follow-up of the randomized groups, symptom improvement was similar, with 16 of 45 children (35.6%) on steroids and 16 of 44 children (36.4%) on saline achieving resolution, indicating no significant difference. At 12 weeks, sustained resolution was noted in 20% of the steroid group and 35.7% of the saline group, but this trend was not statistically significant due to small sample sizes.

The researchers concluded that recommending intranasal saline for an initial period of three months before reassessing could decrease the need for polysomnography and surgical interventions for OSDB in children.