Steroids for Pediatric Apnea Research in Kids

NCT ID: NCT02180672

Last Updated: 2021-11-10

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

211 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-09-30

Study Completion Date

2021-10-30

Brief Summary

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This double-blind, randomized controlled trial will evaluate the use of nasal corticosteroids for the treatment of the childhood obstructive sleep apnea syndrome (OSAS). Efficacy, duration of action and side-effects will be determined.

Detailed Description

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Several studies have suggested that Nasal corticosteroids (NCS) or leukotriene antagonists may be effective in the treatment of childhood OSAS. However, these studies have been limited by factors such as small size, lack of randomization and blinding, short-term follow-up, involvement of children with only very mild OSAS, and/or lack of stratifying for the presence of atopy. Therefore, investigators will plan a randomized controlled trial evaluating the efficacy and safety of NCS vs placebo in children with mild to moderate OSAS. The overall hypothesis is that NCS will be safe and efficacious in the treatment of mild to moderate childhood OSAS, particularly in children with asthma/atopy, but will require ongoing maintenance therapy.

Conditions

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Obstructive Sleep Apnea Syndrome

Keywords

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Obstructive sleep apnea syndrome OSA sleep apnea nasal steroids corticosteroids

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Nasal steroids

Participants randomly assigned to this study arm will receive a 3-month course of nasal steroids (nasal fluticasone).

Group Type ACTIVE_COMPARATOR

Nasal Fluticasone

Intervention Type DRUG

One spray per nostril, per day.

Placebo

Participants randomly assigned to this study arm will receive a 3-month course of placebo nasal spray (saline).

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

One spray per nostril, per day.

Interventions

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Nasal Fluticasone

One spray per nostril, per day.

Intervention Type DRUG

Placebo

One spray per nostril, per day.

Intervention Type DRUG

Other Intervention Names

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NCS Nasal steroids Nasal corticosteroids Saline

Eligibility Criteria

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Inclusion Criteria

1. 5-10 years of age.
2. Mild to moderate OSAS, defined as an obstructive apnea index of 1-20/hr of total sleep time or obstructive apnea hypopnea index of 2-30/hr of total sleep time.
3. Parent-related symptoms of habitual snoring (\>3 nights per week)
4. No history of adenotonsillectomy.
5. Parental/guardian permission (informed consent) and if appropriate, child assent

Exclusion Criteria

1. Severe OSAS or significant hypoxemia or hypercapnia on polysomnography, such that definitive treatment should not be delayed (AHI \> 30/hr, more than 2% total sleep time with arterial oxygen saturation (SpO2) \<90%, end-tidal carbon dioxide partial pressure (PCO2) \> 60 mm Hg for \> 5 minutes, pathologic arrhythmias).
2. History of recurrent throat infections (as defined by the American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines For Tonsillectomy (7)) in the past few years as follows: \> 7 episodes in the past year or \> 5 episodes/year over the past 2 years or \> 3 episodes/year over the past 3 years.
3. Abnormalities on baseline safety screening tests, i.e., Dual Energy X-ray Absorptiometry (DXA) scan showing spine or whole body bone mineral density \< -2.0 standard deviations using race specific curves with adjustment for height Z-score; morning cortisol \< 3 µg/dl or morning adrenocorticotropic hormone (ACTH) \< 10 pg/ml; or ophthalmologic exam demonstrating cataracts (except those with \< 2 mm anterior polar cataracts), aphakia or other ocular abnormalities such as glaucoma, retinal coloboma, intraocular inflammation or microphthalmia.
4. Failure to thrive (weight/height \< 5th percentile for age and gender), as this may be secondary to OSAS.
5. Severe obesity (BMI z-score \> 3) as OSAS is likely to persist in these subjects.
6. Previous adenoidectomy unless adenoidal tissue has been documented to have regrown.
7. Previous tonsillectomy.
8. Continuous positive airway pressure (CPAP) therapy.
9. Any NCS use in the past 3 months or NCS use for \> 2 weeks in the past year.
10. Current immunotherapy or daily antihistamine use.
11. Recent (past month) nasal septum ulcers, surgery or trauma.
12. Other major illness other than asthma, such as craniofacial anomalies, endocrine or neuromuscular disease, or past history of cancer. This includes children with conditions that may be worsened by OSAS, such as hypertension or diabetes.
13. Current use of ketoconazole or other potent CYP3A4 inhibitors.
14. Families planning to move out of the area within the year.
15. Subjects who do not speak either English or Spanish well enough to complete the validated neurobehavioral instruments.
16. Parents/guardians or subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures.
Minimum Eligible Age

5 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Children's Hospital of Philadelphia

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Carole L Marcus, MBBCh

Role: PRINCIPAL_INVESTIGATOR

Children's Hospital of Philadelphia

Locations

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Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Chidambaram AG, Cielo CM, Chervoneva I, Spergel JM, Tapia IE. Nasal biomarker inflammatory profile in response to intranasal corticosteroids in pediatric obstructive sleep apnea syndrome. J Clin Sleep Med. 2025 Jun 1;21(6):1033-1040. doi: 10.5664/jcsm.11604.

Reference Type DERIVED
PMID: 40051199 (View on PubMed)

Tapia IE, Shults J, Cielo CM, Kelly AB, Elden LM, Spergel JM, Bradford RM, Cornaglia MA, Sterni LM, Radcliffe J. A Trial of Intranasal Corticosteroids to Treat Childhood OSA Syndrome. Chest. 2022 Oct;162(4):899-919. doi: 10.1016/j.chest.2022.06.026. Epub 2022 Jun 30.

Reference Type DERIVED
PMID: 35779610 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Related Links

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Other Identifiers

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R01HL120909

Identifier Type: NIH

Identifier Source: secondary_id

View Link

14-010942

Identifier Type: -

Identifier Source: org_study_id