Last Updated: 2008-07-07 10:53:48 -0400 (Reuters Health)

Intranasal budesonide given for 6 weeks benefits children with mild obstructive sleep apnea syndrome (OSAS), according to a report in the July Pediatrics.

Intranasal corticosteroids have been shown to reduce the size of the upper airway lymphoid tissues and thereby provide favorable outcomes in more severe pediatric OSAS, the authors explain.

Dr. Leila Kheirandish-Gozal and Dr. David Gozal from the University of Louisville, Kentucky studied 62 children with mild OSAS in a randomized, crossover trial comparing a 6-week course of intranasal budesonide (32 mcg per nostril at bedtime) with placebo.

Budesonide treatment was associated with significant improvements in several polysomnography measures, the authors report, as well as with significant reductions in adenoid size.

Just over half the children (54.1%) had normalization of their obstructive apnea/hypopnea index (OAHI), the report indicates.

Eight weeks after discontinuation of intranasal budesonide, there were sustained improvements in polysomnography characteristics, degree of respiratory disturbance, and adenoid size.

Administration of placebo produced no changes for most of the measurements, with the exception of a mild worsening of the OAHI.

"On the basis of this compelling…evidence, this study strongly supports the initiation of intranasal corticosteroid therapy in children with mild OSAS as the first step in the treatment of these children," the authors conclude. Rather than resorting to adenotonsillectomy, they add, "We believe that the cumulative experience regarding the use of budesonide would endorse ‘temporarily throwing away the scalpel’ for those symptomatic children with mild OSAS."

Pediatrics 2008;122:e149-e155.