A randomized trial has shown that intranasal saline can effectively treat obstructive sleep-disordered breathing (OSDB) in children. In the study, 29.5% of children aged 3 to 12 experienced symptom resolution after an initial 6-week course of treatment with intranasal saline. For those with ongoing symptoms, an additional 6 weeks of saline proved similarly effective as switching to intranasal steroids, with 35.6% of children on saline becoming symptom-free compared to 36.4% on steroids. The difference was not statistically significant (risk difference -0.9%, 95% CI -20.7 to 19.0, P=0.93).
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Dr. Gillian M. Nixon and her colleagues from the Melbourne Children's Sleep Centre reported these findings in JAMA Pediatrics. The researchers suggest that intranasal saline should be administered for up to 3 months before considering specialist referral for further diagnosis or surgical intervention. They indicated that this approach could alleviate pressure on specialist services while efficiently managing symptoms in primary care.
Intranasal steroids, commonly prescribed for OSDB over the last two decades, were previously validated in smaller controlled trials, while saline treatments have mainly been explored in rhinitis contexts. The MIST trial provided evidence of saline's efficacy for OSDB, with the latest MIST+ trial reinforcing this finding. Both the saline and steroid groups achieved about a 40% symptom resolution rate during the initial 6-week treatment, indicating that saline acts as more than just an inert placebo.
The MIST+ trial involved 150 children referred for significant OSDB symptoms to two tertiary children's hospitals in Australia. The criteria excluded those with prior surgery on respiratory structures, high body mass index, active infections, or recent corticosteroid use. Each child received daily saline spray for six weeks, leading to approximately 50% overall symptom resolution.
Parental perceptions evolved throughout the study, with a slight decline in those believing their child needed surgery (from 64.5% to 56.3%) and those requiring specialist appointments (from 92.9% to 89.4%). At follow-up visits at 6 and 12 weeks, 76.3% and 64.9% of children respectively demonstrated persistent symptom resolution.
Satisfaction levels between the saline and steroid groups remained comparable. However, symptom resolution at 12 weeks favored saline over steroids (35.7% vs 20.0%), though this finding was not statistically significant. Subgroup analyses indicated that there was no distinct group benefiting more or less from treatment, suggesting that saline could be effective for all children with OSDB symptoms. The study noted that the lack of a placebo group was a limitation, but spontaneous resolution in this cohort was deemed unlikely given their long-standing symptoms.