Resident Physician University of California San Francisco San Francisco, California
Introduction: Recent studies have shown that the use of leukotriene modifiers like oral montelukast can serve a therapeutic role in the treatment of pediatric obstructive sleep apnea (OSA) by reducing its severity and the magnitude of adenoid and/or tonsillar hypertrophy. The objective of this study was to determine whether the use of montelukast impacts OSA and/or sleep disordered breathing (SDB) outcomes in children, including surgery risk and time to surgery.
Methods: A retrospective cohort study was performed to compare risk and time to surgery for children diagnosed with OSA and/or SDB at University of California San Francisco between January 1, 2017 and December 31, 2020. The primary outcomes were surgery (adenotonsillectomy and tonsillectomy or adenoidectomy alone) and time to surgery. Multivariate analyses were performed to determine predictors of surgery after adjusting for age and sex. Kaplan-Meier curves were created to determine the impact of montelukast use on time to surgery.
Results: A total of 6,402 patients with mean age 7.23 ± 4.10 years were included in the analysis; 26.3% were treated with oral montelukast. There was a significant difference between patients who were treated with and without montelukast and ultimately underwent adenotonsillectomy (18.3% vs 39.4%, p<0.001). There was also a significant difference between adenoidectomy and tonsillectomy alone. Patients treated with montelukast had a smaller risk of surgery (hazard ratio 0.52, 95% CI 0.47-0.59, p<0.001) and longer time to surgery (5.77 ± 0.3 vs 2.2 ± 0.5 months, p<0.001), even after adjustment for age, sex, BMI percentile, and nasal steroid use.
Conclusion: Patients treated with montelukast for OSA and/or SDB were significantly less likely to undergo sleep surgery than those not treated with montelukast.