Montelukast for mild OSA in children

Obstructive sleep apnoea (OSA) is a relatively common condition in children with a peak incidence between 2-6 years, coincident with the maximal size of adenotonsillar tissue relative to the upper airway. OSA has effects on neurocognition and behaviour which may be reversed by adenotonsillectomy. However, surgical treatment carries risks which are increased in children with OSA and children under the age of 3 years. Recent studies have suggested that anti-inflammatory treatment with nasal corticosteroids or with anti-leukotriene agents may be an alternative to surgery. Montelukast is an anti-leukotriene receptor antagonist with minimal risk of adverse effects. A randomised double-blind placebo-controlled trial of montelukast for the treatment of OSA related to adenotonsillar hypertrophy in children is proposed. Following a sleep study (PSG) showing mild OSA, children will be randomised to a once daily dose of Montelukast or placebo for 8 weeks. At the end of treatment a repeat sleep study will be performed as well as measures of disease-specific quality of life, behaviour, attention and cognition.