Childhood Sleep Apnea Medication
- Author: Mary E Cataletto, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP more...
No effective pharmacologic therapy for childhood obstructive sleep apnea is recognized. Individuals with obstructive sleep apnea and hypersomnolence should have the underlying cause of their obstructive apnea addressed, rather than use stimulant medication during the day in an attempt to help stay alert.
Nocturnal supplemental oxygen is generally not advised as a primary treatment for obstructive sleep apnea. Although oxygen may blunt the degree of hemoglobin desaturation during sleep, it does not prevent sleep fragmentation, sleep deprivation, or associated autonomic stimulation during the obstructive episodes. Preoperative supplemental oxygen treatment has been reported to worsen obstructive hypoventilation in some children. Therefore, if oxygen is used as a bridge to more definitive therapy, the effect of supplemental oxygen should be documented during nocturnal polysomnography.
Intranasal fluticasone propionate (Flonase) administered daily for 6 weeks has been shown to ameliorate the frequency of obstructive events in children with documented mild-to-moderate obstructive sleep apnea caused by tonsil and/or adenoid hypertrophy by about one half. Intranasal corticosteroids have not been shown to decrease obstructive symptoms, eliminate the need for surgery, prevent oxygen desaturation, or shrink tonsil or adenoid tissue; therefore, if intranasal corticosteroids are used, the treatment is only temporary pending a more permanent solution. Systemic corticosteroids have not been shown effective and have no role in treatment.
Preliminary studies suggest an oral leukotriene modifier therapy may reduce the severity of obstructive sleep apnea; however, this intervention is currently considered investigational. Intranasal budesonide used for 6 weeks has been demonstrated to lead to a sustained improvement in mild obstructive sleep apnea but is unproven as therapy for severe obstructive sleep apnea.
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