Inhaled steroids are another option for obese children with OSA. “Using an inhaled steroid can sometimes decrease the size of the adenoids and tonsils, and that can help some kids improve their sleep quality,” Dr. Pont said. A 2008 Pediatrics study of non-obese children found that a six-week course of intranasal budesonide reduced the severity of mild OSA in 54.1 percent of children treated with the steroids. The effect persisted for at least eight weeks post-treatment (Pediatrics. 2008;122(1):e149-e155).
Explore this issue:July 2012
Inhaled steroids are expected to be included as a possible treatment modality for OSA in the next American Academy of Pediatrics Clinical Practice Guideline for the Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome, which should be released later this year.
The Importance of Collaboration
Effectively treating OSA in the obese pediatric population requires close collaboration among a host of medical experts, and such collaboration may be strange to otolaryngologists and sleep specialists who are used to treating OSA with minimal assistance. But reaching out to obesity experts benefits both patients and physicians. “If you just approach the OSA from an ENT standpoint alone, you’re destined for failure in a large percentage of these kids,” said Dr. Kaplan. “The otolaryngologist may be the point person initially, but obstructive sleep apnea in an obese child has to be managed closely with the child’s primary care doctor or pediatrician and all of the other various members of the team if you really want to see long-term success.”