Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, Chengdu, China.
Sleep Medicine Center, Mental Health Center, Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Sleep Med. 2024 Apr;116:129-137. doi: 10.1016/j.sleep.2024.01.030. Epub 2024 Feb 6.
Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking.
This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population.
PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA.
Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children.
Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839).
MAIN OUTCOME(S) AND MEASURE(S): The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2).
17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %).
The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.
儿科阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，会对儿童的健康和发育产生重大负面影响。目前仍缺乏对不同药物干预治疗儿童 OSA 的综合评估。
本研究旨在对儿科人群阻塞性睡眠呼吸暂停的药物治疗进行全面系统评价和网络荟萃分析。
从 1950 年到 2022 年 11 月，通过 PubMed、Web of Science、Embase、The Cochrane Library 和中国知网（CNKI）搜索儿科 OSA 的相关文献。
多位审阅者纳入了关于儿童 OSA 药物治疗的随机对照试验（RCT）。
多位观察者遵循 PRISMA NMA 声明的指导，进行数据提取和评估。采用贝叶斯网络荟萃分析（固定效应模型）比较纳入药物干预的加权均数差（WMD）、对数优势比（log OR）和累积排序曲线下面积（SUCRA）。我们的方案在 PROSPERO 网站（CRD42022377839）上进行了注册。
主要结局是呼吸暂停/低通气指数（AHI）的改善，次要结局包括不良事件和最低动脉血氧饱和度（SaO2）。
最终纳入 17 项 RCT 研究，共纳入 1367 名年龄 2-14 岁的 OSA 儿童。最终有 10 种药物纳入研究。结果显示，与安慰剂相比，糠酸莫米松+孟鲁司特（WMD-4.74[95%CrIs -7.50 至 -2.11]）、布地奈德（-3.45[-6.86 至 -0.15]）和孟鲁司特（-3.41[-5.45 至 -1.39]）在改善 AHI 值方面具有显著的治疗效果，95%CrIs 排除了无效应。此外，糠酸莫米松+孟鲁司特对 AHI（85.0%）和 SaO2（91.0%）的 SUCRA 值均非常高。
糠酸莫米松鼻喷雾剂联合口服孟鲁司特钠的组合显示出最高的有效性概率。需要进一步研究来评估这些干预措施在儿科 OSA 患者中的长期疗效和安全性。
