A new study led by the Murdoch Children’s Research Institute in Australia has uncovered a revolutionary new treatment for sleep disordered breathing in children, and it’s as simple as a nasal spray. The study, published in JAMA Pediatrics, found that a saline nasal spray was just as effective as a steroid nasal spray in reducing snoring and breathing difficulties in children after just six weeks of treatment.
The “MIST” trial, carried out at The Royal Children’s Hospital and Monash Children’s Hospital, enrolled 276 children aged 3-12 years. The results showed that both types of nasal sprays cleared symptoms in 40% of the cases, and the number of children who needed to have their tonsils removed was halved.
Tonsillectomy is a common elective surgery for children in Australia, with over 40,000 procedures performed annually. The procedure is costly, painful, and puts a significant strain on hospital resources. Dr. Alice Baker, from the Murdoch Children’s Research Institute, explains that children in Victoria often have to wait over a year in the public system for surgery, leading the team to search for an alternative treatment.
Dr. Baker explains, “Nasal sprays work by cleaning the nose and reducing inflammation not just in the nose but all the way down the back of the throat to the adenoids and tonsillar tissue, alleviating the symptoms.”
Snoring and breathing difficulties, such as mouth breathing and apnea (abnormally long pauses in respiration) during sleep affect 12% of children and can have long-term effects on cognitive function, behavior, and cardiovascular health. The main cause of these problems — collectively known as sleep disordered breathing (SDB) — is enlarged tonsils and/or adenoids (the patch of tissue that sits in the back of the nasal cavity).
A 2021 study published in Nature Communications found a clear link between habitual snoring (three or more nights a week) and behavioral problems in children, such as inattention or hyperactivity. The researchers also uncovered evidence that these problems may be associated with changes in the structure of the brain’s frontal lobe.
Another 2008 study, this time a meta-analysis (a study that aggregates data from multiple other studies), found that SDB can seriously stunt children’s growth. Children with SDB who had their tonsils surgically removed experienced accelerated increases in both weight and height, which was much greater than expected.
The new study from Australia found that a substantial number of children with sleep-disordered breathing could be initially managed by their GP, using six weeks of an intranasal saline spray as a first-line treatment. This would not only improve the quality of life for affected children but also reduce waiting times and hospital costs.
The next step for the research team is to explore if certain children would benefit more from using a steroid spray instead of a saline spray. The recruitment for the MIST+ Trial is currently underway, and interested parties can email for more information.