Efficacy of leukotriene receptor antagonist in children with obstructive sleep apnea: A systematic review and meta-analysis

Abstract

Background: Obstructive sleep apnea (OSA) is a common disease in children. The most common cause is adenotonsillar hypertrophy. Adenotonsillectomy is the first line therapy. However, there are complications such as bleeding and respiratory compromise. Leukotriene receptor antagonist is an antiinflamatory medication which also use for treatment of OSA in children.
Objective: To conduct a systematic review and meta-analysis to evaluate the effect of leukotriene receptor antagonist (LTRA) on obstructive sleep apnea (OSA) in children.
Methods: Data source was a comprehensive search of MEDLINE, Scopus, Ovid, Web of Science, and the Cochrane Library both of which were reviewed in May 2018. Manual searches and subject matter expert inputs were also obtained. This review included studies assessing the efficacy of LTRA for the treatment of OSA in children, wherein apnea hypopnea indexes (AHI) were reported.
Results: A total of three studies (143 patients) met our inclusion criteria. Pooled random effects analysis demonstrated a statistically significant improvement of polysomnographic respiratory events, with average AHI reduction of 2.72 events per hour, [95% confidence interval (CI) (- 3.95, - 1.49); P < 0.0001] and overall increase in minimal arterial oxygen saturation of 3.27% [95%CI 1.78, 4.77); P < 0.0001] in favor of LTRA. Significant reduction in adenoidal-nasopharyngeal ratio (A/N ratio) in favor of LTRA of 0.21 [95% CI (- 0.25, - 0.17); P < 0.00001] was also demonstrated.
Conclusion: Leukotriene receptor antagonist provided benefits in children with OSA, by reducing AHI, increasing minimal arterial oxygen saturation and reducing adenoid size. Data were based on meta-analysis of control trials with 12 - 16 months of follow up.