Leukotriene modifier therapy for mild sleep-disordered breathing in children.
BACKGROUND
Children with mild sleep-disordered breathing (SDB), who may not be recommended for adenotonsillectomy, frequently exhibit neurocognitive and behavioral morbidity, and may benefit from alternative therapeutic interventions, such as leukotriene modifier therapy.


METHODS
Twenty-four children with SDB completed an open-label intervention study for 16 weeks with daily montelukast therapy. Sleep studies and adenoid size estimates from lateral X-ray films of the neck were obtained before and after treatment. In a parallel study, adenoid and tonsillar tissues from children with obstructive sleep apnea or recurrent throat infections were subjected to quantitative polymerase chain reaction, immunohistochemistry, and Western blotting for gene and protein expression of leukotriene receptors LT1-R and LT2-R, and for concentrations of LTB4 and LTC4/D4/E4.


RESULTS
Montelukast treatment induced significant reductions in adenoid size and respiratory-related sleep disturbances, which were absent in 16 children with SDB who did not receive treatment. LT1-R and LT2-R mRNA was similarly abundant in adenoid tissues, but increased LT1-R and LT2-R protein expression and higher levels of LTB4 and LTC4/D4/E4 emerged in children with obstructive sleep apnea.


CONCLUSIONS
Oral therapy with a leukotriene modifier appears to be associated with improved breathing during sleep. Double-blind, placebo-controlled trials will be needed to corroborate current findings and solidly establish antiinflammatory strategies, such as leukotriene modifiers, as therapeutic alternatives in children with SDB too mild to justify referral for adenotonsillectomy.
Goldbart
Aviv D
AD
Kosair Children's Hospital Research Institute, University of Louisville, KY 40202, USA.
Goldman
Julie L
JL
Veling
Maria C
MC
Gozal
David
D
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D017286:Polysomnography; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D018077:Receptors, Leukotriene / Q000378:metabolism; D012891:Sleep Apnea Syndromes / Q000188:drug therapy* / Q000378:metabolism; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D018077:Receptors, Leukotriene; D013440:Sulfides; C039280:leukotriene A receptor; C093875:montelukast