Treat Kids’ Sleep Apnea Without Surgery

Montelukast for mild sleep apnea appears effective in children in small study

(RxWiki News) Sleep apnea in children can lead to serious health problems. Many children don't like to wear masks for treatment, and parents may not want them to have surgery.

A recent study shows there may be a third option.

A medication called montelukast appeared to help children with mild sleep apnea.

"Talk to your child's doctor about treating sleep apnea."

The study was led by Dr. Aviv D. Goldbart, MD, of the Department of Pediatrics, the Pediatric Pulmonary and Sleep Research Laboratory and the Sleep-Wake Disorders Center at Ben-Gurion University's Soroka University Medical Center in Israel.

Dr. Goldbart and two colleagues conducted the study to test whether the medication montelukast (brand name Singulair) could work for children who have obstructive sleep apnea.

One of the usual treatments for sleep apnea in children is surgery to remove their tonsils and/or adenoids. Adenoids are similar to tonsils but located higher in the throat, behind the nose and out of sight.

However, some parents may prefer not to take the surgical option for their children because there are risks of infection, bleeding and dehydration for the children. Also, the surgery does not always fix the sleep apnea.

In this study, 46 children had obstructive sleep apnea, diagnosed from sleep studies. None of the children were obese, and all had moderate sleep apnea, which means they stopped breathing less than 10 times an hour while asleep.

All the children snored, but none had used montelukast before, none had an upper respiratory infection, none had taken antibiotics in the previous month and none had had a surgery to remove their tonsils.

Half the children received a daily pill of montelukast of 4 or 5 mg (depending on their age), and the other half received a fake pill.

The children, their parents and the person giving the children the pills did not know whether it was the real or fake pill.

The trial lasted for 12 weeks. Before and after the trial, the children had sleep studies and had their adenoids measured. The children's parents also filled out questionnaires before and after the study.

The study found that over half the children taking montelukast had better results on their sleep study at the end of the trial.

For 65 percent of the children taking montelukast (15 of the 23 kids), their measure of apnea decreased by more than 50 percent.

This means if they stopped breathing 8 times an hour before the study, they now stopped 4 times or less per hour.

The children who took montelukast also had a decrease in the size of their adenoids by about 30 percent.

William Kohler, MD, director of Pediatric Sleep Services at Florida Hospital Tampa, said he has not used montelukast, but he found the study very interesting because it may offer a third option for children with sleep apnea.

"It would be another alternative to consider for children whose parents won't agree to the surgery or children who wouldn't be able to tolerate the CPAP," Dr. Kohler told dailyRx News. He said some parents refuse the surgery because of their concern about the rare but serious possible complications that can occur with any surgery.

CPAP stands for continuous positive airway pressure. It is another treatment for sleep apnea that requires a person to wear a mask which pushes air into their lungs while they sleep.

Dr. Kohler cautioned that the study was very small and the montelukast did not cure the sleep apnea because the children still had it. But it did improve their symptoms.

"The bottom line is this does give another therapeutic alternative, and more studies would be beneficial to see if it could be another therapeutic intervention," he said.

He would also like to see studies on whether montelukast could help children who do have the surgery to remove their tonsils and adenoids but continue to have apnea symptoms, which sometimes happens.

None of the children in the study experienced side effects from the montelukast, but it was a very small study, so there were not enough children taking the medication to determine possible side effects.

Some people who take montelukast may experience headache, dizziness, heartburn, stomach pain or tiredness. If these symptoms are severe or don't go away, you should tell your doctor.

You should also call your doctor immediately if a more serious possible side effect occurs, such as difficulty breathing or swallowing, swelling anywhere on a person's head or their lower legs and feet, itching, rash, hives, hoarseness, fever, flu-like symptoms, numbness or pins and needles in arms or legs or pain and swelling in the sinuses.

The study was published August 6 in the journal Pediatrics. The research was funded by MSD (Merck) Israel and by an Israel Science Foundation grant.

Senior author Dr. Asher Tal disclosed that he has done speaking events for the pharmaceutical companies MSD (Merck), Teva and Sanofi-Aventis. The other two authors declared no competing interests.

Review Date: 
August 20, 2012