The combination therapy of Mometasone and Montelukast emerges as the frontrunner in treating obstructive sleep apnea, OSA (the most prevalent form of sleep-related breathing disorder) in children.

The objective of this research is to perform an extensive systematic review and network meta-analysis of medication-based treatments for addressing OSA in children.

An extensive search included exploring PubMed, Web of Science, Embase, The Cochrane Library, and China National Knowledge Infrastructure (CNKI) from 1950 till November 2022 to include randomized controlled trials (RCTs) concerning pharmacological therapies for OSA in children.

The guidance of the PRISMA for Network Meta-Analyses statement was considered for data extraction and evaluation. Bayesian network meta-analyses, utilizing a fixed-effect model, were conducted to compare various metrics including weighted mean difference (WMD), surface under the cumulative ranking curves (SUCRA) and logarithmic odds ratios (log OR) for the evaluated pharmacological therapies.

Improvements in the apnea-hypopnea index (AHI) were the primary outcomes, on the other hand, adverse events and the lowest arterial oxygen saturation (SaO2) were the secondary outcomes.

Out of 17 RCTs involving 1367 children (age group: 2 to 14 years) with obstructive sleep apnea (OSA) fulfilling the inclusion criteria, 10 therapies were ultimately analyzed. The findings indicated that Mometasone Montelukast combination, Budesonide and Montelukast demonstrated significantly superior therapeutic effects in comparison to the placebo concerning the apnea-hypopnea index (AHI) value, Table 1:

Furthermore, remarkably high SUCRA values for both AHI (85%) and SaO2 (91%) were found for the Mometasone Montelukast combination. 

Mometasone nasal spray when used along with Montelukast oral shows the greatest likelihood of being the most effective treatment intervention. Further research is needed to investigate their long-term safety and efficacy for OSA in paediatrics.