Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of partial (hypopnea) or complete (apnea) upper airway obstruction during sleep despite ongoing respiratory efforts, resulting in disruption of sleep (arousal). OSA affects 9% of middle-aged men and 3% of women in North America. In children, the prevalence ranges between 1% to 5% depending on the diagnostic criteria. If left untreated, OSA can lead to fatigue, somnolence, headaches, cardiovascular disease, decreased quality of life, and increased risk of motor vehicle accidents.
The gold standard assessment for OSA is polysomnography, a test that measures neurologic and cardio-respiratory parameters during sleep. The frequency of obstructive events measured during polysomnography is reported as the apnea-hypopnea index (AHI). According to the American Academy of Sleep Medicine, the severity of OSA is defined by the following AHI cut-offs: mild, ≥ 5 and < 15 events/hour; moderate, ≥ 15 and < 30 events/hour; severe, ≥ 30 events/hour. OSA is often accompanied by clinical symptoms such as excessive daytime sleepiness, behavioural and mood problems, morning headaches, and difficulty concentrating.
Treatment options for OSA include weight loss, dental devices or oral appliance therapy, surgical procedures, and continuous positive airway pressure (CPAP). Adenotonsillectomy is the primary treatment for children with adenotonsillar hypertrophy, the most common underlying risk factor for the development of pediatric OSA. Surgical procedures can be painful and post-operative complications may occur, making non-invasive treatments a useful option for patients contraindicated for surgery or who have residual OSA after surgery.
Leukotrienes are inflammatory mediators in the respiratory system and are involved in the propagation of inflammation in children with OSA. Elevated levels of leukotriene receptors were found in tonsils from children with OSA. Montelukast (Singulair) is a leukotriene receptor antagonist used as therapy for asthma and allergic rhinitis and has been considered as a therapy option for children with mild OSA due to its anti-inflammatory properties.
The purpose of this review is to examine the clinical effectiveness, cost effectiveness and guidelines regarding the use of montelukast for the treatment of sleep apnea.
Contents
- CONTEXT AND POLICY ISSUES
- RESEARCH QUESTIONS
- KEY FINDINGS
- METHODS
- SUMMARY OF EVIDENCE
- CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
- REFERENCES
- APPENDIX 1 Selection of Included Studies
- APPENDIX 2 Summary of Study Characteristics
- APPENDIX 3 Summary of Critical Appraisal
- APPENDIX 4 Summary of Findings
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Bookshelf ID: NBK195647PMID: 24741731
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