Treatment and Outcome of Intra Nasal Steroids Spray on Pediatric Sleep Disordered Breathing Due to Enlarged Adenoids

Abstract

Introduction: Sleep disordered breathing (SDB) in children is described as a spectrum of respiratory abnormalities ranging from loud snoring to obstructed sleep apnea. Common symptoms include snoring, mouth breathing, daytime sleepiness, fatigue, mood disturbance and irritability. Complications of SDB are multi system like cardio-respiratory, neuro-cognitive, endocrine and metabolic disturbances. Adenotonsillar hypertrophy is the commonest cause of SDB and choice of treatment is adenotonsillectomy under general anesthesia. This study was done to diagnose SDB caused by adenoid hypertrophy and evaluation of impact of the disease on quality of life (QOL) in children and to evaluate the efficacy of intranasal steroid (fluticasone furoate) spray in pediatric SDB with QOL by using OSA-18 questionnaires. Methods: It is a prospective observational study conducted among 52 children (2-12 years old). All patients received intra nasal fluticasone furoate spray (27.5 microgram) in each nostril once daily for 8 weeks. They were evaluated at pretreatment and post treatment with obstructive sleep apnea (OSA-18) quality of life questionnaire. Study was done during 1-year period of time in a tertiary care center, Green Life Medical College, Dhaka. Results: Statistically significant improvement (p<0.000) in QOL was observed in 73.1% patients who were recruited for the study. The mean pre medication OSA-18 total score showed 78.3 improvement to 46.83 in post medication. Conclusion: Medical treatment with intranasal steroid (fluticasone furoate) nasal spray for 8 weeks can be an effective treatment option in pediatric SDB patients due to enlarge adenoid without significant complications. OSA-18 questionnaires are quick, validated survey procedure of evaluating sleep disordered breathing in children as well as assessment of quality of life. So medical treatment can be an alternative to surgical treatment in children with mild to moderate SDB and surgical management is only indicated in severe cases when medical treatment fails.

Journal of Green Life Med. Col. 2025; 10(2): 52-57