Prioritizing Practical Treatment Options for Pediatric Sleep-Disordered Breathing

Specialty treatment is often called upon for pediatric sleep-disordered breathing, but there may be a more accessible option available through primary care.

Neurology Learning Network spoke with Kristen P. Perrett, associate professor, Department of Pediatrics, University of Melbourne, Australia, and Gillian M. Nixon, associate professor, Department of Pediatrics, Monash University, Australia, about their study “Effectiveness of Intranasal Mometasone Furoate vs Saline for Sleep-Disordered Breathing in Children: A Randomized Clinical Trial,” recently published in JAMA Pediatrics.

In Part 2 of this interview, Drs Perrett and Nixon explain why intranasal spray a comparable treatment to tonsillectomy and future directions for research on the treatment of snoring in children.

Missed Part 1 of this fascinating Q&A? Find it here! For more expert insights for your practice, visit our Sleep Disorders Excellence Forum.

Editor’s Note: This interview has been lightly edited for length and clarity.

Brionna Mendoza, Associate Digital Editor, Neurology Learning Network (NLN): What misconceptions about this topic would you like to clarify about this topic for our audience?

Drs. Kristen P. Perrett and Gillian M. Nixon: Tonsillectomy is the most common paediatric elective surgery for children in Australia with more than 40,000 performed each year. It is commonly used to treat children’s snoring and is highly effective for more severe forms of breathing difficulty during sleep. However, the procedure is costly, painful, and a significant burden on hospital resources, with many families typically waiting more than a year in the public system for surgery.

Our results show an improvement in symptoms after 6 weeks of using a steroid or saline nasal spray, which may reduce the need for surgery. However, further investigation is needed to assess long-term outcomes. Our MIST+ follow up study will explore this, as well as whether certain children will benefit more from using the steroid nasal spray rather than a saline nasal spray.

Mendoza, NLN: What future areas of inquiry do your findings point towards or that you might be pursuing?

Perrett and Nixon: We have followed up the children in our MIST Trial for 2 years. Analysis of the follow-up data will allow us to determine whether the effect of the nasal sprays persists beyond the 6 weeks of treatment.

As mentioned, we will also explore if there are certain children who will benefit more from using the steroid spray rather than a saline spray. These findings will help provide evidence for a potential new model of care. Recruitment is underway for the MIST+ Trial. To find out more, please visit mcri.edu.au/research/projects/mist-plus or email mist@mcri.edu.au.

Mendoza, NLN: Any final thoughts on your study that you’d like to share with our audience?

Perrett and Nixon: Snoring and breathing problems in sleep are very common in childhood and associated with significant daytime consequences, including adverse effects on learning, behavior, and the cardiovascular system. First-line treatment is usually with adenotonsillectomy. Practical ways of addressing this common problem are needed and may result in fewer children needing surgical intervention with its attendant costs and risks. 

Thank you to the co-authors on this paper: Alice Baker, Anneke Grobler, Karen Davies, Amanda Griffiths, Harriet Hiscock, Haytham Kubba, Rachel L Peters, Sarath Ranganathan, Joanne Rimmer, Elizabeth Rose, Katherine Rowe, Catherine M Simpson and Andrew Davidson.

Thank you to the children, and their families, who participated in this important research.

Thank you also to our funders: the Trial was funded by research grants from The Passe and Williams Foundation, Murdoch Children’s Research Institute, the Royal Children’s Hospital Foundation, and the Monash Health Foundation awarded to Associate Professor Kirsten Perrett, Associate Professor Gillian Nixon and Dr Alice Baker.

Associate Professor Gillian Nixon, MBChB, FRACP, MD, Grad Cert Hlth Serv Mt, is a pediatric respiratory and sleep physician with both academic and clinical appointments. Her clinical practice as Deputy Director of the Melbourne Children’s Sleep Centre at Monash Children’s Hospital is centered on the management of children with respiratory and sleep disorders, placing her in an ideal situation to both raise clinical questions for research and to translate research into practice directly. A/Prof Nixon's academic appointment is in the Department of Paediatrics, Monash University. She is also the Head of Paediatric Sleep Research in the Melbourne Children’s Sleep Centre. A/Prof Nixon's research is focussed on improvements in the diagnostic and treatment pathway for snoring and obstructive sleep apnoea in children, including developing simplified diagnostic tools and driving improvements in evidence-based treatment pathways. She has recently held a Translating Research into Practice fellowship from the National Health and Medical Research Council to support this research. She has a postgraduate qualification in Health Service Management and is focussed on improving care for children through improvements in health care systems. She has built cross-disciplinary collaborations and worked with state government 2018-2020 on related quality improvement projects regarding the management of the large number of children with snoring and obstructive sleep apnoea, a condition with significant negative effects on learning and development.

Associate Professor Kirsten Perrett, MBBS (Hons), FRACP, PhD, is Group Leader of the Population Allergy Group and Deputy Directory of the Melbourne Children’s Trials Centre at the Murdoch Children’s Research Institute (MCRI). She is also Director of the National Allergy Centre of Excellence (NACE) and the Centre for Food & Allergy Research (CFAR), hosted at MCRI; Paediatric Allergist and Vaccinologist at The Royal Children's Hospital, Melbourne and an Honorary Principal Fellow at The University of Melbourne. For more than 15 years, A/Prof Perrett has spear-headed Investigator-led and industry-sponsored vaccine and food allergy clinical trials and is a highly sought-after trials expert and food allergy clinician scientist. warded a 2022-26 National Health and Medical Research Council (NHMRC) Investigator Award and 2018-2027 Melbourne Children’s Clinician-Scientist Fellowship, A/Prof Perrett has also received more than $47.5 million in competitive, government, philanthropic and industry research funding and has more than 100 peer-reviewed publications, including 85 in the past five years. Her research has helped shape world-wide changes to food allergy prevention, diagnosis and management. A/Prof Perrett’s current program of clinical trials research focuses on investigating novel strategies for the prevention and early intervention/treatment of food allergy, eczema and atopic disease. She is also involved in research investigating immunological mechanisms underlying allergic disease pathogenesis and exploring strategies to improve the diagnostic accuracy of minimally invasive tests for food allergy diagnosis.