Montelukast improves obstructive sleep apnea

Children with nonsevere obstructive sleep apnea (OSA) who took the oral leukotriene modifier montelukast daily for 12 weeks showed reductions in severity of symptoms and adenoid size, a new study reports.

Montelukast reduces inflammation by interfering with the expression of cysteinyl leukotriene receptor-1. Overexpression of these receptors in the tonsils and adenoids leads to inflammation and enlargement. The size of the tonsils and adenoids primarily determines the severity of OSA.

The double-blind, randomized, placebo-controlled study assigned 46 children, aged 2 to 10 years with mild to moderate OSA diagnosed by polysomnography, to receive either placebo or montelukast 4 mg per day (children aged <6 years) or 5 mg per day (children aged ≥6 years) for 12 weeks. The children were assessed before and after treatment by polysomnography, parent questionnaire, and radiographs to evaluate adenoid size.

Polysomnography showed significant improvement in respiratory disturbance-a decrease in the obstructive apnea index of more than 50%-in 65.2% of the 23 children who received montelukast. Treated children also had improved sleep symptoms and reduced adenoid size compared with the placebo group. None of the children who took montelukast experienced adverse events.

Montelukast treatment is recommended mainly for children with enlarged adenoids rather than children whose only symptom of OSA is enlarged tonsils. That is because the drug’s major anti-inflammatory effect occurs in the adenoids even though leukotriene receptors are also overexpressed in the tonsils of children with OSA. The researchers emphasized that they are not advocating anti-inflammatory agents for obese children inasmuch as none of the children in the study was obese.

Researchers conclude that montelukast may be a safe, effective alternative to offer parents before or instead of surgery (adenotonsillectomy) for children with nonsevere OSA. However, surgery may still be necessary if the child does not respond to anti-inflammatory treatment.

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