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Mild OSA – medical trial — RACP Paediatrics MCQ

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ModerateRespiratoryMild OSA – medical trialRACP Paediatrics

A 3-year-old has mild OSA (AHI 3/hr) with grade 2 tonsillar hypertrophy and nasal obstruction from adenoid hypertrophy. Parents prefer to avoid surgery initially. What is a reasonable trial of medical therapy?

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Correct answer: A — Intranasal corticosteroids

For mild OSA, a trial of intranasal corticosteroids (mometasone or fluticasone) for 6-12 weeks may reduce adenoidal size and improve OSA. Montelukast is sometimes added. If symptoms persist or worsen, adenotonsillectomy should be reconsidered. A repeat sleep study after medical therapy guides further management.

Reference: RCH Melbourne – 2023 – OSA CPG; RACP Paediatric Curriculum – Respiratory