Therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome in children

Oct 24, 2017World journal of pediatrics : WJP

How different medicines help children with obstructive sleep apnea

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Abstract

Fluticasone and budesonide show promising therapeutic effects for obstructive sleep apnea/hypopnea syndrome (OSAHS) in children.

The therapeutic effects of fluticasone, budesonide, montelukast, and intranasal mometasone furoate were significantly better than placebo based on apnea hypopnea index (AHI) values.
Fluticasone demonstrated superior effectiveness compared to placebo in improving sleep efficiency.
Sucralfate and clindamycin also showed better therapeutic effects than placebo according to visual analogue scale results.
No significant differences were found in the therapeutic effects of various drugs on OSAHS when analyzed through network meta-analysis.
Fluticasone achieved a high SUCRA value of 86.6% for AHI, while budesonide had a SUCRA value of 94.0% for sleep efficiency.

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BACKGROUND: This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.

METHODS: PubMed, Embase and Cochrane Library were searched from the inception of each database to November 2015. Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study. Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children.

RESULTS: A total of seven RCTs were finally incorporated into our network meta-analysis. Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate, montelukast, budesonide and fluticasone concerning apnea hypopnea index (AHI) value [WMD=1.40, 95% confidence interval (CI)=1.17-1.63; WMD=2.80, 95% CI=1.01-4.59; WMD=3.50, 95% CI=3.34-3.66; WMD=7.20, 95% CI=5.26-9.14, respectively], and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50, 95% CI=2.42-4.58); regarding visual analogue scale, the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94, 95% CI=1.13-2.75; WMD=1.06, 95% CI=0.22-1.90), and sucralfate is better than clindamycin (WMD=-0.88, 95% CI=-1.65 to -0.11). However, network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency. Furthermore, the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment.

CONCLUSIONS: Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children, thus providing an important guiding significance for the treatment of OSAHS in children.

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Therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome in children

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