University of Oklahoma Health Sciences Center

Error message

Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 695 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 696 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 697 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 700 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_environment_initialize() (line 702 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 328 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 329 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 337 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in include_once() (line 344 of /home/rprlib/prod72/www/sites/default/settings.php).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_settings_initialize() (line 819 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: ini_set(): Session ini settings cannot be changed after headers have already been sent in drupal_settings_initialize() (line 828 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Warning: session_name(): Session name cannot be changed after headers have already been sent in drupal_settings_initialize() (line 831 of /home/rprlib/prod72/www/includes/bootstrap.inc).
Deprecated function: Return type of DatabaseStatementBase::execute($args = [], $options = []) should either be compatible with PDOStatement::execute(?array $params = null): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2244 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::current() should either be compatible with Iterator::current(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::next() should either be compatible with Iterator::next(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::key() should either be compatible with Iterator::key(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::valid() should either be compatible with Iterator::valid(): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).
Deprecated function: Return type of DatabaseStatementEmpty::rewind() should either be compatible with Iterator::rewind(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in require_once() (line 2346 of /home/rprlib/prod72/www/includes/database/database.inc).

Author/s:

Gillian M. Nixon, Deborah Anderson, Alice Baker

Date Added:

March 4, 2026

Journal/Publication:

JAMA Pediatrics

Publication Date:

January 20, 2026

URL:

Intranasal Treatments for Children With Sleep-Disordered Breathing: The MIST+ Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.5717

PMID (1):

41557344

Keywords

Sleep Apnea Syndromes

sleep apnea

Obstructive sleep apnea

Polysomnography

Mometasone Furoate

MeSH

sleep apnea syndromes

Sleep Apnea

Sleep Apnea, Obstructive

Polysomnography

Mometasone Furoate

RPR Commentary

Treatment of children with sleep disordered breath with intranasal saline was effective. James W. Mold, MD, MPH

Abstract

Importance: Symptoms of obstructive sleep apnea are common in childhood and associated with significant comorbidity. Surgical treatment with adenotonsillectomy is first-line treatment but medical treatments show potential to improve symptoms and reduce the need for surgery.

Objective: To determine the efficacy of 6 weeks of intranasal steroid (INS) compared with saline in children with obstructive sleep-disordered breathing (OSDB) with persistent symptoms after a 6-week intranasal saline run-in.

Design, setting, and participants: This was a double-blind, placebo-controlled, randomized clinical trial involving specialist clinic waitlists at 2 sites in Australia. Included were children aged 3 to 12 years. Study data were analyzed from January to June 2025.

Interventions: All children received once-daily intranasal saline for 6 weeks (run-in). Those with persisting symptoms (SDB score ≥-1) were randomized to either once-daily intranasal mometasone furoate, 50 µg, (INS) or continued saline for a further 6 weeks.

Main outcomes and measures: The primary outcome was symptom resolution (SDB score <-1). Secondary outcomes included behavior, quality of life, and parental perception of need for surgery. Analyses were adjusted for site and baseline measures.

Results: A total of 150 children (mean [SD] age, 6.2 [2.3] years; 93 male [62%]) were recruited. Of 139 children who completed the run-in phase, 41 (29.5%) had symptom resolution after saline run-in. Among 93 children randomized to intervention groups (47 INS; 46 saline), symptom resolution occurred in 35.6% (95% CI, 22.9%-50.6%) and 36.4% (95% CI, 23.5%-51.6%) of the INS and saline group, respectively, with no evidence for a clinically significant difference between groups (risk difference, -0.9%; 95% CI, -20.7% to 19.0%; P = .93). No group differences were found in secondary outcomes. Subgroup analysis did not reveal a group more or less likely to respond to medical treatment.

Conclusions and relevance: Results of this randomized clinical trial show that 6 weeks of intranasal saline resolved OSDB symptoms in nearly one-third of children. An additional 6-week course of INS or saline led to resolution in another one-third (total resolution around 50%), with no added benefit from INS. Intranasal saline is an effective short-term first-line treatment for OSDB before consideration of polysomnography or surgical intervention. Results suggest that saline should be recommended for 3 months before assessing the need for specialist referral.