SNORING, difficulty breathing, and other issues during sleep are symptoms of sleep-disordered breathing (SDB) in children. SDB is linked with significant morbidity and affects approximately 12% of children. The multicentre Murdoch Children’s Research Institute (MIST) clinical trial reported that saline and intranasal mometasone furoate had similar efficacy in remedying symptoms of SDB in children.
From 2018–2020, the MIST trial recruited 276 patients, aged 3–12 years old, who were referred to a specialist for serious SDB symptoms. The participants were randomly assigned to receive 6 weeks of daily intranasal treatment with either mometasone furoate (50 μg) or sodium chloride (saline, 0.9%). The primary outcome was characterised as a reduction of SDB symptoms to a level no longer requiring referral to a specialist, as per the American Academy of Pediatrics (AAP) guidelines, at 6 weeks, measured by parental report of symptoms.
Kirsten Perrett, of the MIST at Royal Children’s Hospital in Melbourne, Australia, and colleagues, reported that the proportion of participants experiencing a resolution of significant SDB symptoms was similar with mometasone (44%) and saline (41%) after 6 weeks of daily treatment. Additionally, the recommendations for surgery declined dramatically in both groups from baseline (62–67%) to 6 weeks (32–38%).
This randomised clinical trial suggests that in primary care, first-line treatment of SDB in children could incorporate 6 weeks of intranasal saline, which may remedy symptoms in a large number of children. The researchers concluded: “it appears possible that a large proportion of children with SDB may be able to be treated successfully by their primary care physician, using 6 weeks of intranasal saline as a first-line treatment.” They also added that “management with less invasive, cheaper, and readily available treatment would increase the quality of life of children with SDB.” Notably, Perrett’s group highlighted that this “would reduce burden on specialist services and therefore allow more timely access for those children who need it most, i.e., those who do not respond to initial primary care medical management. This, in turn, could reduce waiting times and improve care for all children with SDB.” In future investigations, Perrett’s group will explore whether treatment with mometasone furoate or saline, or merely the natural history of the condition, was responsible for the study results.