Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

1. This randomized controlled trial found that children with obstructive sleep apnea syndrome (OSAS) had significantly higher nasal resistance than those without OSAS.

2. However, in participants who were effectively treated with intranasal corticosteroids and oral montelukast, there were improvements in nasal resistance, nasal minimal cross-sectional area, and nasal cavity volume.

Evidence Rating Level: 1 (Excellent)

Obstructive sleep apnea syndrome (OSAS) is a common condition in children that can have detrimental effects on overall health and quality of life. Given that tonsil and adenoid hypertrophy are associated with the development of OSAS, removing these tissues is the standard treatment for children. However, prior research has found that children can experience a complete resolution of their OSAS symptoms without experiencing changes in the size of their tonsils or adenoids. Thus, other factors are being investigated for playing a role in the etiology of OSAS, including nasal ventilation function (NVF). This study aimed to examine the role of NVF in children with OSAS and evaluate the impact of NVF on the efficacy of drug treatments in this population.

This randomized controlled trial included 109 patients with OSAS and 116 without, forming the control group. Participants in the OSAS group were included if they were diagnosed with OSAS based on polysomnography, their symptoms persisted for at least 12 months, and they had no history of tonsillectomy and/or adenoidectomy. Patients were excluded if they had a history of nasal disease, nasal anatomic anomalies, cranial and facial deformity, immunodeficiency, cardiovascular disease, or had recently undergone corticosteroid treatment. The control group consisted of healthy participants who underwent physical examination at the same hospital during the same time period. Patients underwent overnight polysomnography (PSG) monitoring and acoustic rhinometry (AR) to assess various measurements of the nasal cavity. The OSAS group then received 12 weeks of treatment with intranasal corticosteroids and oral montelukast and underwent PSG and AR measurements again at the end of treatment. The primary outcomes were the different measures of NVR, including nasal resistance (NR), nasal minimal cross-sectional area (NMCA), nasal cavity volume (NCV), and nasopharyngeal volume (NPV).

The results demonstrated that OSAS patients had significantly higher NR and smaller NMCA, NCV, and NPV than those in the control group. The OSAS participants who were effectively treated with intranasal corticosteroids and oral montelukast demonstrated significant improvements in NR, NMCA, and NCV but not NPV. However, the study was limited by its small sample size, which may have impacted the results. Nonetheless, the present study demonstrated the importance of NVF in the etiology and treatment of OSAS in children.

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