sleep apnea syndromes

Importance: Symptoms of obstructive sleep apnea are common in childhood and associated with significant comorbidity. Surgical treatment with adenotonsillectomy is first-line treatment but medical treatments show potential to improve symptoms and reduce the need for surgery.

Objective: To determine the efficacy of 6 weeks of intranasal steroid (INS) compared with saline in children with obstructive sleep-disordered breathing (OSDB) with persistent symptoms after a 6-week intranasal saline run-in.

Design, setting, and participants: This was a double-blind, placebo-controlled, randomized clinical trial involving specialist clinic waitlists at 2 sites in Australia. Included were children aged 3 to 12 years. Study data were analyzed from January to June 2025.

Interventions: All children received once-daily intranasal saline for 6 weeks (run-in). Those with persisting symptoms (SDB score ≥-1) were randomized to either once-daily intranasal mometasone furoate, 50 µg, (INS) or continued saline for a further 6 weeks.

Main outcomes and measures: The primary outcome was symptom resolution (SDB score <-1). Secondary outcomes included behavior, quality of life, and parental perception of need for surgery. Analyses were adjusted for site and baseline measures.

Results: A total of 150 children (mean [SD] age, 6.2 [2.3] years; 93 male [62%]) were recruited. Of 139 children who completed the run-in phase, 41 (29.5%) had symptom resolution after saline run-in. Among 93 children randomized to intervention groups (47 INS; 46 saline), symptom resolution occurred in 35.6% (95% CI, 22.9%-50.6%) and 36.4% (95% CI, 23.5%-51.6%) of the INS and saline group, respectively, with no evidence for a clinically significant difference between groups (risk difference, -0.9%; 95% CI, -20.7% to 19.0%; P = .93). No group differences were found in secondary outcomes. Subgroup analysis did not reveal a group more or less likely to respond to medical treatment.

Conclusions and relevance: Results of this randomized clinical trial show that 6 weeks of intranasal saline resolved OSDB symptoms in nearly one-third of children. An additional 6-week course of INS or saline led to resolution in another one-third (total resolution around 50%), with no added benefit from INS. Intranasal saline is an effective short-term first-line treatment for OSDB before consideration of polysomnography or surgical intervention. Results suggest that saline should be recommended for 3 months before assessing the need for specialist referral.

Author/s:

Gillian M. Nixon, Deborah Anderson, Alice Baker

Intranasal Treatments for Children With Sleep-Disordered Breathing: The MIST+ Randomized Clinical Trial

Megan George — Wed, 21 Jan 2026 18:12:26 +0000

Date Added:

January 21, 2026

Journal/Publication:

JAMA

Publication Date:

January 20, 2026

URL:

Intranasal Treatments for Children With Sleep-Disordered Breathing: The MIST+ Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.5717

Keywords

sleep disorders

adolescents

Intranasal Treatments

sleep apnea

PMID (1):

41557344

MeSH

Humans

male

Polysomnography

sleep apnea syndromes

Once daily intranasal saline reduces sleep disordered breathing in children as well as or better than intranasal steroids. James W. Mold, MD, MPH

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Trial registration: ClinicalTrials.gov Identifier: NCT05382494.

Author/s:

Gillian M. Nixon, Deborah Anderson, Alice Baker

Diagnosis and Treatment of Obstructive Sleep Apnea

Megan George — Tue, 19 Aug 2025 16:04:58 +0000

Date Added:

August 19, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

August 18, 2025

URL:

Diagnosis and Treatment of Obstructive Sleep Apnea

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

40824669

Keywords

pulmonary medicine

sleep medicine

Obstructive sleep apnea

PMID (1):

10.1001/jamainternmed.2025.2318

MeSH

Sleep Apnea

Sleep Apnea, Obstructive

Polysomnography

Pulmonary

sleep apnea syndromes

A review of the diagnosis and management of patients with obstructive sleep Apnea. James W. Mold, MD, MPH

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This Clinical Insights discusses the role primary care clinicians have in screening, diagnostic testing, and treatment of patients with obstructive sleep apnea.

Author/s:

Alejandra C. Lastra, Julie M. Neborak, Babak Mokhlesi

What Is Atrial Fibrillation?

Erin Blanchette — Wed, 30 Apr 2025 21:32:57 +0000

Date Added:

April 30, 2025

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

April 24, 2025

URL:

What Is Atrial Fibrillation?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2025.2888

Keywords

atrial fibrillation

Cardiology

Patient Information

jama Patient Information

Rhythm Disorders

PMID (1):

40272794

MeSH

myocardial infarction

hypertension

stroke

sleep apnea syndromes

Information for patients about atrial fibrillation. James W. Mold, MD, MPH

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Atrial fibrillation is an abnormal heart rhythm that can cause stroke, heart failure, heart attack, chronic kidney disease, dementia, and death.

Atrial fibrillation is classified as paroxysmal (intermittent episodes lasting 7 days or less), persistent (lasting more than 7 days), long-standing persistent (lasting more than 1 year), or permanent.1

In the US, atrial fibrillation affects about 10.55 million people and is more common among men than women. Other risk factors include older age, smoking, high blood pressure, diabetes, heart disease, high alcohol consumption, sleep apnea, an overactive thyroid gland, and possibly genetic factors.

Author/s:

Rebecca Voelker

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Jeffrey Wilson — Wed, 22 Aug 2018 15:57:24 +0000

Date Added:

November 1, 2018

Journal/Publication:

CHEST

Publisher:

American College of Chest Physicians

Publication Date:

March 1, 2018

Issue:

Volume:

153

Pages:

665-674

URL:

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.chest.2017.10.044

Keywords

CPAP

OSA

oronasal mask

PMID (1):

29273515

MeSH

masks

continuous positive airway pressure

sleep apnea syndromes

In adults with obstructive sleep apnea, oronasal CPAP requires higher pressures, is less effective for reducing AHI, and is associated with reduced adherence compared with nasal CPAP.

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BACKGROUND:

Nasal CPAP is the "gold standard" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA.

METHODS:

The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" and "CPAP" or "sleep apnea" and "oronasal mask" or "OSA" and "oronasal CPAP" or "oronasal mask" and "adherence." Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence.

RESULTS:

We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night).

CONCLUSIONS:

Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.

Author/s:

Andrade, Rafaela G. S., Viana, Fernanda M., Nascimento, Juliana A., Drager, Luciano F., Moffa, Adriano, Brunoni, André R., Genta, Pedro R., Lorenzi-Filho, Geraldo