Saline effective for children with sleep-disordered breathing: Study

Anastasia Tsirtsakis

18/01/2023 3:05:53 PM

New research shows many patients can continue being managed by their GP, halving the number requiring surgery.

A dad administers a nasal spray to his daughter.
A saline nasal spray is just as effective as an anti-inflammatory steroid.

About one in 10 children will experience snoring or breathing difficulties during their sleep.
This can have a range of long-term consequences, with the potential to impact everything from a child’s cognitive function and behaviour to their cardiovascular health.
As it stands, a common treatment is a tonsillectomy – a costly and painful surgical procedure to remove the tonsils – with more than 40,000 performed each year.
But new research published in JAMA Pediatrics suggests that almost one-half of children with sleep-disordered breathing could initially be managed by their GP, and may not require a specialist referral, as is currently recommended.
That’s thanks to the effectiveness of a simple and much less invasive solution – a saline nasal spray.
The study, led by the Murdoch Children’s Research Institute (MCRI), involved 276 children with sleep-disordered breathing aged 3–12. Half of the participants were given a six-week course of intranasal saline and the other half an intranasal corticosteroid.
The findings revealed the saline to be just as effective as the corticosteroid, with both nasal sprays resulting in the resolution of symptoms in approximately 40% of participants.
With wait times for tonsillectomies in Victoria currently standing at over 12 months – and likely similar across other states and territories – study coordinator Dr Alice Baker said there is a need to look at alternative treatments.
‘Nasal sprays work by cleaning the nose and/or reducing inflammation, not just in the nose but all the way down the back of the throat to the adenoids and tonsillar tissue to alleviate the symptoms,’ she said.
In addition to significantly reducing both snoring and breathing difficulties, the study also found that children assessed by a surgeon as needing their tonsils and/or adenoids removed post the six-week treatment was reduced by half.
Dr Baker said some children being referred for surgery may be having the procedure unnecessarily.
Among the participants was seven-year-old Thomas, Stephen Graham and Emily Tuner-Graham’s son, who started snoring at the age of three.  
The parents feared their son would eventually need surgery, but were relieved to discover that that will no longer be necessary.
‘Prior to joining the trial, a specialist recommended having his tonsils out,’ they said. ‘It’s a such huge relief that by just using a nasal spray his breathing difficulties have cleared.’
Meanwhile, the study highlighted the important role GPs have to play.
As it stands, it is currently recommended children with sleep disordered breathing be referred to specialist services. However, MCRI’s Group Leader and Clinician-Scientist Fellow Associate Professor Kirsten Perrett said the study shows that a significant number of paediatric patients could initially be managed by their GP.
‘A large proportion of children who snore and have breathing difficulties could be managed successfully by their primary care physician, using six weeks of an intranasal saline spray as a first-line treatment,’ she said.
‘Using this cheaper and readily available treatment would increase the quality of life of these children, reduce the burden on specialist services, decrease surgery waiting times and reduce hospital costs.’
Tonsillectomy is currently the most common elective surgery for children in Australia, with more than 40,000 performed each year.
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Dr Megan Elizabeth Elliott-Rudder   19/01/2023 5:21:57 PM

Nasal saline for childhood sleep disorders sounds great. But at 1 spray per nostril daily, does this just mean the steroid is acting as a placebo and many kids will just get better? I can't imagine that much saline has a big therapeutic effect.

Dr Abdullah Fadil Abdullah Alsharik   23/01/2023 10:26:55 PM

What happen after 6 weeks? Does it mean children not need any further therapy in long-term?