{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T10:48:27Z","timestamp":1785926907613,"version":"3.56.0"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n Importance<\/jats:title>\n Symptoms of obstructive sleep apnea are common in childhood and associated with significant comorbidity. Surgical treatment with adenotonsillectomy is first-line treatment but medical treatments show potential to improve symptoms and reduce the need for surgery.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the efficacy of 6 weeks of intranasal steroid (INS) compared with saline in children with obstructive sleep-disordered breathing (OSDB) with persistent symptoms after a 6-week intranasal saline run-in.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a double-blind, placebo-controlled, randomized clinical trial involving specialist clinic waitlists at 2 sites in Australia. Included were children aged 3 to 12 years. Study data were analyzed from January to June 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n All children received once-daily intranasal saline for 6 weeks (run-in). Those with persisting symptoms (SDB score \u2265\u22121) were randomized to either once-daily intranasal mometasone furoate, 50 \u00b5g, (INS) or continued saline for a further 6 weeks.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was symptom resolution (SDB score &amp;lt;\u22121). Secondary outcomes included behavior, quality of life, and parental perception of need for surgery. Analyses were adjusted for site and baseline measures.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 150 children (mean [SD] age, 6.2 [2.3] years; 93 male [62%]) were recruited. Of 139 children who completed the run-in phase, 41 (29.5%) had symptom resolution after saline run-in. Among 93 children randomized to intervention groups (47 INS; 46 saline), symptom resolution occurred in 35.6% (95% CI, 22.9%-50.6%) and 36.4% (95% CI, 23.5%-51.6%) of the INS and saline group, respectively, with no evidence for a clinically significant difference between groups (risk difference, \u22120.9%; 95% CI, \u221220.7% to 19.0%;\n P<\/jats:italic>\n \u2009=\u2009.93). No group differences were found in secondary outcomes. Subgroup analysis did not reveal a group more or less likely to respond to medical treatment.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this randomized clinical trial show that 6 weeks of intranasal saline resolved OSDB symptoms in nearly one-third of children. An additional 6-week course of INS or saline led to resolution in another one-third (total resolution around 50%), with no added benefit from INS. Intranasal saline is an effective short-term first-line treatment for OSDB before consideration of polysomnography or surgical intervention. Results suggest that saline should be recommended for 3 months before assessing the need for specialist referral.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05382494<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapediatrics.2025.5717","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T16:00:25Z","timestamp":1768924825000},"page":"240","source":"Crossref","is-referenced-by-count":4,"title":["Intranasal Treatments for Children With Sleep-Disordered Breathing"],"prefix":"10.1001","volume":"180","author":[{"given":"Gillian M.","family":"Nixon","sequence":"first","affiliation":[{"name":"Melbourne Children\u2019s Sleep Centre, Monash Children\u2019s Hospital, Monash Health, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Anderson","sequence":"additional","affiliation":[{"name":"Population Allergy, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Baker","sequence":"additional","affiliation":[{"name":"Population Allergy, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Department of General Medicine, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Anaesthetics and Pain, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Melbourne Children\u2019s Trial Centre, Melbourne Children\u2019s, Melbourne, Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Respiratory Disease Infection and Immunity, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Respiratory and Sleep Medicine, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anneke C.","family":"Grobler","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Clinical Epidemiology and Biostatistics Unit, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon","family":"Pinczower","sequence":"additional","affiliation":[{"name":"Population Allergy, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of General Medicine, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Rimmer","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology and Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia"},{"name":"Department of Surgery, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia"},{"name":"Department of Otolaryngology, University of Melbourne, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris J.","family":"Selman","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics Unit, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Clinical Infections, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Centre for Community Child Health, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moya","family":"Vandeleur","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Respiratory Disease Infection and Immunity, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Respiratory and Sleep Medicine, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten P.","family":"Perrett","sequence":"additional","affiliation":[{"name":"Population Allergy, Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"},{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Department of Allergy and Immunology, Royal Children\u2019s Hospital, Melbourne, Victoria, Australia"},{"name":"National Allergy Centre of Excellence, Parkville, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"4","key":"poi250078r1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.109.4.e69","article-title":"Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome.","volume":"109","author":"Schechter","year":"2002","journal-title":"Pediatrics"},{"issue":"6","key":"poi250078r2","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1111\/coa.13436","article-title":"An epidemiological study of pediatric adenotonsillectomy in Victoria, Australia, 2010-2015: changing indications and lack of effect of hospital volume on interhospital transfers.","volume":"44","author":"Tran","year":"2019","journal-title":"Clin Otolaryngol"},{"issue":"6","key":"poi250078r3","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1016\/j.otohns.2009.01.044","article-title":"Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005.","volume":"140","author":"Erickson","year":"2009","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"25","key":"poi250078r4","doi-asserted-by":"publisher","first-page":"2366","DOI":"10.1056\/NEJMoa1215881","article-title":"A randomized trial of adenotonsillectomy for childhood sleep apnea.","volume":"368","author":"Marcus","year":"2013","journal-title":"N Engl J Med"},{"issue":"6","key":"poi250078r5","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1001\/jamapediatrics.2025.0023","article-title":"Adenotonsillectomy and health care utilization in children with snoring and mild sleep apnea: a randomized clinical trial.","volume":"179","author":"Bakker","year":"2025","journal-title":"JAMA Pediatr"},{"issue":"21","key":"poi250078r6","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1001\/jama.2023.22114","article-title":"Adenotonsillectomy for snoring and mild sleep apnea in children: a randomized clinical trial.","volume":"330","author":"Redline","year":"2023","journal-title":"JAMA"},{"issue":"7","key":"poi250078r7","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1001\/jamaoto.2020.0869","article-title":"Effectiveness of adenotonsillectomy vs watchful waiting in young children with mild to moderate obstructive sleep apnea: a randomized clinical trial.","volume":"146","author":"Fehrm","year":"2020","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"4","key":"poi250078r8","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1177\/0194599817742597","article-title":"Intranasal budesonide and quality of life in pediatric sleep-disordered breathing: a randomized controlled trial.","volume":"158","author":"Gudnadottir","year":"2018","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"3","key":"poi250078r9","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.otorri.2019.04.004","article-title":"Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy.","volume":"71","author":"Ghafar","year":"2020","journal-title":"Acta Otorrinolaringol Esp (Engl Ed)"},{"issue":"10","key":"poi250078r10","doi-asserted-by":"publisher","first-page":"2657","DOI":"10.1007\/s00405-013-2364-9","article-title":"The role of mometasone furoate nasal spray in the treatment of adenoidal hypertrophy in the adolescents: a prospective, randomized, cross-over study.","volume":"270","author":"Yilmaz","year":"2013","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"poi250078r11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2024.111899","article-title":"The impact of intranasal corticosteroids in a prospective cohort of children with sleep disordered breathing.","volume":"178","author":"Rowe","year":"2024","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"poi250078r12","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/01455613221123860","article-title":"Efficacy of topical azelastine and fluticasone dipropionate combination in children with adenoid hypertrophy.","volume":"102","author":"Bilgili","year":"2023","journal-title":"Ear Nose Throat J"},{"key":"poi250078r13","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.ijporl.2019.06.027","article-title":"Impact of montelukast and fluticasone on quality of life in mild pediatric sleep apnea.","volume":"125","author":"Bluher","year":"2019","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"2","key":"poi250078r14","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1002\/ppul.20079","article-title":"Nasal corticosteroids for children with snoring.","volume":"38","author":"Alexopoulos","year":"2004","journal-title":"Pediatr Pulmonol"},{"issue":"3","key":"poi250078r15","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.sleep.2014.10.015","article-title":"Intranasal corticosteroids for mild childhood obstructive sleep apnea: a randomized, placebo-controlled study.","volume":"16","author":"Chan","year":"2015","journal-title":"Sleep Med"},{"issue":"6","key":"poi250078r16","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1067\/mpd.2001.114474","article-title":"Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea.","volume":"138","author":"Brouillette","year":"2001","journal-title":"J Pediatr"},{"issue":"1","key":"poi250078r17","doi-asserted-by":"publisher","first-page":"e149","DOI":"10.1542\/peds.2007-3398","article-title":"Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome.","volume":"122","author":"Kheirandish-Gozal","year":"2008","journal-title":"Pediatrics"},{"issue":"3","key":"poi250078r18","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1001\/jamapediatrics.2022.5258","article-title":"Effectiveness of intranasal mometasone furoate vs saline for sleep-disordered breathing in children: a randomized clinical trial.","volume":"177","author":"Baker","year":"2023","journal-title":"JAMA Pediatr"},{"issue":"1","key":"poi250078r19","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/S0022-3476(84)80348-0","article-title":"A diagnostic approach to suspected obstructive sleep apnea in children.","volume":"105","author":"Brouilette","year":"1984","journal-title":"J Pediatr"},{"issue":"3","key":"poi250078r20","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1542\/peds.2012-1671","article-title":"Diagnosis and management of childhood obstructive sleep apnea syndrome.","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"issue":"246","key":"poi250078r21","first-page":"1","article-title":"2000 CDC growth charts for the US: methods and development.","author":"Kuczmarski","year":"2002","journal-title":"Vital Health Stat 11"},{"issue":"1","key":"poi250078r22","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1542\/peds.109.1.45","article-title":"Centers for Disease Control and Prevention 2000 growth charts for the US: improvements to the 1977 National Center for Health Statistics version.","volume":"109","author":"Ogden","year":"2002","journal-title":"Pediatrics"},{"issue":"1","key":"poi250078r23","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1177\/014556139807700111","article-title":"Aplasia of the epiglottis: a rare congenital anomaly.","volume":"77","author":"Bonilla","year":"1998","journal-title":"Ear Nose Throat J"},{"issue":"12","key":"poi250078r24","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1097\/00005537-199912000-00002","article-title":"Clinical predictors of obstructive sleep apnea.","volume":"109","author":"Friedman","year":"1999","journal-title":"Laryngoscope"},{"issue":"1","key":"poi250078r25","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/S1389-9457(99)00009-X","article-title":"Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems.","volume":"1","author":"Chervin","year":"2000","journal-title":"Sleep Med"},{"key":"poi250078r26","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.ijporl.2018.07.029","article-title":"The OSA-5: development and validation of a brief questionnaire screening tool for obstructive sleep apnea in children.","volume":"113","author":"Soh","year":"2018","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1 Pt 1","key":"poi250078r27","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1067\/mhn.2000.105254","article-title":"First place resident clinical science award 1999\u2014quality of life for children with obstructive sleep apnea.","volume":"123","author":"Franco","year":"2000","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"8","key":"poi250078r28","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1097\/00005650-200108000-00006","article-title":"PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations.","volume":"39","author":"Varni","year":"2001","journal-title":"Med Care"},{"issue":"11","key":"poi250078r29","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1097\/00004583-200111000-00015","article-title":"Psychometric properties of the strengths and difficulties questionnaire.","volume":"40","author":"Goodman","year":"2001","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"12","key":"poi250078r30","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1177\/000348940411301208","article-title":"The Glasgow Children\u2019s Benefit Inventory: a new instrument for assessing health-related benefit after an intervention.","volume":"113","author":"Kubba","year":"2004","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"3","key":"poi250078r31","doi-asserted-by":"publisher","first-page":"e662","DOI":"10.1542\/peds.2014-3099","article-title":"Utility of symptoms to predict treatment outcomes in obstructive sleep apnea syndrome.","volume":"135","author":"Rosen","year":"2015","journal-title":"Pediatrics"},{"issue":"1","key":"poi250078r32","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007074.pub3","article-title":"Anti-inflammatory medications for obstructive sleep apnoea in children.","volume":"1","author":"Kuhle","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"poi250078r33","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1016\/j.ijporl.2015.07.009","article-title":"Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children.","volume":"79","author":"Chohan","year":"2015","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"poi250078r34","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.sleep.2024.01.030","article-title":"Pharmacological interventions for pediatric obstructive sleep apnea (OSA): network meta-analysis.","volume":"116","author":"Zhang","year":"2024","journal-title":"Sleep Med"},{"issue":"1","key":"poi250078r35","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1378\/chest.126.1.13","article-title":"Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection.","volume":"126","author":"Goldbart","year":"2004","journal-title":"Chest"},{"issue":"6","key":"poi250078r36","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1001\/archoto.2011.86","article-title":"Effect of fluticasone furoate on interleukin 6 secretion from adenoid tissues in children with obstructive sleep apnea.","volume":"137","author":"Esteitie","year":"2011","journal-title":"Arch Otolaryngol Head Neck Surg"},{"issue":"4","key":"poi250078r37","doi-asserted-by":"publisher","first-page":"301","DOI":"10.23736\/S2724-5276.19.05563-4","article-title":"Relationship between sleep quality and rhinitis in children: role of medical treatment with isotonic and hypertonic saline.","volume":"73","author":"Marcuccio","year":"2021","journal-title":"Minerva Pediatr (Torino)"},{"issue":"2","key":"poi250078r38","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1159\/000481093","article-title":"Efficacy of buffered hypertonic saline nasal irrigation for nasal symptoms in children with seasonal allergic rhinitis: a randomized controlled trial.","volume":"174","author":"Malizia","year":"2017","journal-title":"Int Arch Allergy Immunol"},{"issue":"4","key":"poi250078r39","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1002\/ajmg.a.20371","article-title":"Prader-Willi syndrome: causes of death in an international series of 27 cases.","volume":"124A","author":"Schrander-Stumpel","year":"2004","journal-title":"Am J Med Genet A"},{"issue":"4","key":"poi250078r40","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1002\/lary.23709","article-title":"Current practice patterns for sleep-disordered breathing in children.","volume":"123","author":"Friedman","year":"2013","journal-title":"Laryngoscope"},{"issue":"4","key":"poi250078r41","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1016\/j.anl.2021.11.001","article-title":"Changes during medical treatments before adenotonsillectomy in children with obstructive sleep apnea.","volume":"49","author":"Kajiyama","year":"2022","journal-title":"Auris Nasus Larynx"}],"container-title":["JAMA Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/articlepdf\/2844085\/jamapediatrics_nixon_2026_oi_250078_1772122140.00694.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T16:00:54Z","timestamp":1772467254000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2844085"}},"subtitle":["The MIST+ Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,3,1]]},"references-count":41,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapediatrics.2025.5717","relation":{},"ISSN":["2168-6203"],"issn-type":[{"value":"2168-6203","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3,1]]}}}