Dexamethasone Treatment for OSA in Children

Dexamethasone as a Novel Treatment for Obstructive Sleep Apnea in Children

This is a double-blinded clinical trial of children diagnosed with moderate to severe obstructive sleep apnea (OSA) on a baseline polysomnogram (PSG). Participants will receive a 3-day course of dexamethasone, an oral steroid, or placebo control and undergo two PSGs to assess the efficacy of dexamethasone, as a treatment to manage the severity and symptoms in children with moderate to severe OSA.

Study Overview

• Status: Recruiting
• Conditions: Obstructive Sleep Apnea
• Intervention / Treatment: Drug: Dexamethasone; Drug: Placebo Control

Detailed Description

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder affecting neonates to adolescents characterized by intermittent partial and complete upper airway obstruction leading to apneas.

The first line of treatment for OSA in young children is an adenotonsillectomy (AT). However, there are long surgical wait times for ATs, up to 3-6 months after a baseline polysomnogram(PSG). This leaves many children untreated, leading to a higher risk of learning deficits and long-term health effects.

Oral corticosteroids have long been used to treat airway inflammation and reduce inflammation of adenoid and tonsil tissue in-vitro. However, there is a lack of knowledge of oral steroids' efficacy in managing OSA. Additionally, the role of the nasal epithelium and the mechanism of action of dexamethasone role at a molecular level is unknown.

The primary objective is to evaluate the efficacy of Dexamethasone in reducing the severity and symptoms of moderate to severe OSA in children in this proof-of-concept exploratory trial.

Participants will be screened by their baseline PSG, followed by 3 study visits conducted at SickKids. Participants will receive a 3-day course of oral dexamethasone or placebo at their first baseline study visit. During baseline, participants will undergo an otolaryngology assessment, a nasal brushing, and questionnaires. Participants will return 2 to 4 weeks after the intervention to the Hospital for Sick Children for a follow-up study visit which includes a repeat PSG, otolaryngology assessment and questionnaires. If no AT is performed within 6 months, participants will return for a third study visit for a repeat PSG, otolaryngology assessment and questionnaires.

• Study Type: Interventional
• Enrollment (Estimated): 22
• Phase: Phase 3

Contacts and Locations

• Study Contact: Name: Mystica Terrance, BSc; Phone Number: 6479261307; Email: mystica.terrance@sickkids.ca

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5V 1X8
      • Recruiting
      • The Hospital for Sick Children
      • Contact: Mystica Terrance, BSc; Email: mystica.terrance@sickkids.ca
      • Principal Investigator: Indra Narang, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 2 years to 10 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Polysomnogram diagnosed with moderate to severe Obstructive sleep apnea (OAHI >5 events/hour)
• Aged 2-10 years
• Presence of adenotonsillar hypertrophy
• Ability to take oral medication and be willing to adhere to the dosing regimen
• Informed consent provided in accordance with institutional policies

Exclusion Criteria:

• Previous adenotonsillectomy
• Presence of symptoms of an upper respiratory tract infection
• Co-existing central sleep apnea
• Hypertension
• Prior or current evidence for abnormal glucose tolerance
• Contraindication for dexamethasone or components of dexamethasone oral suspension,
• Treatment with nasal or systemic corticosteroids within 4 weeks prior to the intervention
• OSA with associated oxygen desaturations <90% for 2 continuous minutes
• Need for non-invasive ventilation long-term due to underlying disease
• Current systemic fungal infections
• Patients with clinically relevant varicella exposure

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Dexamethasone Treatment; Oral Dexamethasone treatment	Drug: Dexamethasone; Dexamethasone Oral Suspension
Placebo Comparator: Placebo Treatment; Placebo control	Drug: Placebo Control; Placebo Oral Mix

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Obstructive apnea-hypopnea index	Change in obstructive apnea-hypopnea index from baseline. The paediatric OSA severity scoring criteria will be used for all participants. Mild OSA is defined as OAHI ≥1 to <5 events/hr; moderate OSA is defined as OAHI ≥5 to <10 events/hr; and severe OSA is defined as OAHI ≥10 events/hr	Baseline and 2-4 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in scores from baseline of the Child Sleep Habits Questionnaire (CSHQ) total score	Total CSHQ score of 41 has been reported to be a sensitive clinical cut-off point for detecting possible sleep problems	Baseline and 2-4 weeks
Change in scores from baseline of the Strengths and Difficulties Questionnaire (SDQ)	The SDQ is a validated parent-reported behavioural screening questionnaire and is used to assess children's mental health. The total difficulties score ranges from 0 to 40, a higher score indicates higher difficulties.	Baseline and 2-4 weeks
Change in scores from baseline of the Obstructive Sleep Apnea-18 Quality of Life (OSA-18 QoL) Survey.	The OSA-18 QoL survey is a validated 18-item quality of life measure for children with sleep-disordered breathing (SDB) for children 2-18. Higher total scores indicate more impact on QoL - minor impact (scores below 60), moderate impact (scores between 60 and 80) and major impact (scores above 80).	Baseline and 2-4 weeks
Soft tissue size (Adenoids, Tonsils & Turbinates)	Change in soft tissue size (adenoids, tonsils and turbinates) from baseline	Baseline and 2-4 weeks
Cytokine levels of Interleukin-8(IL-8), Interleukin-1b(IL1b), and Tumor Necrosis Factor a (TNFa) at baseline	Inflammatory markers will be measured in basal media of cells cultured from nasal brushing by ELISA	At baseline
Inflammatory gene expression of Interleukin-8, Interleukin-1b, Nuclear factor kappa-B (NF-kB) and Tumor Necrosis Factor a (TNFa)	Cells from nasal brushing will be cultured and harvested for RNA to study gene expression.	At baseline
Participant recruitment rate	Feasibility determined by participant recruitment rate	From study start to completion; up to 6 months
Participant retention rate	Feasibility determined by participant retention rate	From study start to completion; up to 6 months
Participant adherence rate	Feasibility determined by participant adherence rate	From study start to completion; up to 6 months
Adverse events	Safety determined by number and severity of adverse events	From study start to completion; up to 6 months

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Investigators: Principal Investigator: Indra Narang, MD, The Hospital for Sick Children

Study record dates

Study Major Dates

• Study Start (Actual): October 26, 2022
• Primary Completion (Estimated): June 30, 2024
• Study Completion (Estimated): June 30, 2024

Study Registration Dates

• First Submitted: November 2, 2022
• First Submitted That Met QC Criteria: December 1, 2022
• First Posted (Actual): December 6, 2022

Study Record Updates

• Last Update Posted (Estimated): January 17, 2024
• Last Update Submitted That Met QC Criteria: January 16, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Corticosteroid; Dexamethasone
• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Apnea; Respiration Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Physiological Effects of Drugs; Autonomic Agents; Peripheral Nervous System Agents; Anti-Inflammatory Agents; Antineoplastic Agents; Antiemetics; Gastrointestinal Agents; Glucocorticoids; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Antineoplastic Agents, Hormonal; Dexamethasone
• Other Study ID Numbers: 1000079288

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No