A simple saline nasal spray could work as effectively as intranasal steroids in relieving symptoms of sleep-disordered breathing in children, according to the findings of the MIST trial published in JAMA Pediatrics.¹

A total of 276 children, aged 3-12 years, with sleep-disordered breathing were recruited to compare the effectiveness of intranasal mometasone furoate (50 μg) versus intranasal saline (0.9%) given as one spray per nostril daily, in alleviating symptoms, which was the primary endpoint of the study and enhancing their quality of life. Majority of the study subjects (53%) were boys. This multicenter, randomized, placebo-controlled trial was carried out at The Royal Childrens Hospital and Monash Childrens Hospital in Melbourne, Australia from June 8, 2018, to February 13, 2020. The follow-up period was for 6 weeks.

Improvement in symptoms occurred in 56/127 (44%) children using intranasal mometasone spray, while among those who used intranasal steroids, 50/123 (41%) children had resolution of their symptoms. Epistaxis and nasal irritation or itch were the major adverse effects observed occurring in 9.7% of children in the intranasal steroid group. In the intranasal saline group, epistaxis occurred in 15% of the participants, while nasal itch or irritation occurred in 18%.

This trial shows that intranasal steroid (mometasone) spray was not superior to intranasal saline spray in relieving symptoms of sleep-disordered breathing. At least 40% of children in both groups had resolution of symptoms. A 50% reduction in the percentage of children requiring tonsillectomy or adenoidectomy was also noted. Hence, children with sleep-disordered breathing could be effectively treated with either intranasal saline or corticosteroid administered by GPs for 6 weeks to start with and “may not require referral to specialist services”.

Reference

1. Baker A, et al. Effectiveness of intranasal mometasone furoate vs saline for sleep-disordered breathing in children: a randomized clinical trial. JAMA Pediatr. 2023 Jan 17. doi: 10.1001/jamapediatrics.2022.5258.