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The article discusses the efficacy and safety of monoclonal anti‐interleukin (IL)‐5 antibodies for treating chronic asthma in both adults and children. Anti‐IL‐5 treatments have been found to reduce the rate of asthma exacerbations in adults with severe asthma, particularly those with elevated blood eosinophils. While improvements in health‐related quality of life and lung function were limited, no safety concerns were identified for mepolizumab and reslizumab, but there was a small incidence of adverse events leading to discontinuation of benralizumab. The study included participants with moderate to severe eosinophilic asthma and found that biologic agents like mepolizumab and benralizumab can be effective in reducing asthma exacerbations and improving quality of life, especially in patients with uncontrolled severe asthma. [Extracted from the article]

Aim: In children with Prader‐Willi syndrome (PWS), growth hormone (GH) improves height and body composition; however, may be associated with worsening sleep‐disordered breathing (SDB). Some studies have reported less SDB after GH initiation, but follow‐up with polysomnography is still advised in most clinical guidelines. Methods: This retrospective, multicentre study, included children with PWS treated with GH at seven PWS treatment centres in Australia over the last 18 years. A paired analysis comparing polysomnographic measures of central and obstructive SDB in the same child, before and after GH initiation was performed with Wilcoxon signed‐rank test. The proportion of children who developed moderate/severe obstructive sleep apnoea (OSA) was calculated with their binomial confidence intervals. Results: We included 112 patients with available paired data. The median age at start of GH was 1.9 years (range 0.1–13.5 years). Median obstructive apnoea hypopnoea index (AHI) at baseline was 0.43/h (range 0–32.9); 35% had an obstructive AHI above 1.0/h. Follow‐up polysomnography within 2 years after the start of GH was available in 94 children who did not receive OSA treatment. After GH initiation, there was no change in central AHI. The median obstructive AHI did not increase significantly (P = 0.13), but 12 children (13%, CI95% 7–21%) developed moderate/severe OSA, with clinical management implications. Conclusions: Our findings of a worsening of OSA severity in 13% of children with PWS support current advice to perform polysomnography after GH initiation. Early identification of worsening OSA may prevent severe sequelae in a subgroup of children. [ABSTRACT FROM AUTHOR]

Montelukast has a short-term beneficial effect for the treatment of OSA in otherwise healthy, non-obese, surgically untreated children with OSA but there is insufficient evidence to recommend use as a first line treatment given the potential for side effects. Anti-inflammatory medications for obstructive sleep apnoea in children.1 Stefan Kuhle, Dorle U Hoffmann, Souvik Mitra, Michael Siegfried Urschitz https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007074.pub3/full?highlightAbstract=obstructiv%7Cobstruct%7Cobstructive%7Cantiinflammatory%7Cantiinflammatori What Is the Review about? The efficacy and safety of anti-inflammatory drugs for the treatment of obstructive sleep apnoea (OSA) in children. [Extracted from the article]

Aim: This study aims to determine whether demographic or clinical factors predict obstructive sleep apnoea (OSA) severity in Australian children.Methods: Demographic details and medical histories of 301 Australian children (3-17 years old) referred for assessment of OSA were examined retrospectively. Children underwent overnight polysomnography and were classified as having primary snoring (PS) (obstructive apnoea hypopnoea index (OAHI) ≤ 1 event per hour; n = 150), mild OSA (>1 OAHI ≤ 5 events per hour; n = 76) or moderate/severe (MS) OSA (OAHI > 5 events per hour; n = 75). Information obtained from parent-report questionnaire determined the predictive value of the following factors for determining OSA severity: gender, ethnicity, body mass index, asthma and/or allergic rhinitis, socio-economic status and parental smoking status (mother/father/both). Chi-squared analyses were used to compare the distribution of the demographic and clinical factors across the three groups. Statistically significant risk factors were subsequently entered into logistic regression analysis.Results: Ethnicity and parental smoking were significant risk factors for MS OSA. Children with non-Caucasian ethnicity were 36% more likely than Caucasian children to be diagnosed with MS OSA than PS (P = 0.002). Children with fathers who smoked were 53% more likely to have MS OSA than PS compared with those with fathers who did not smoke (P = 0.008). Obesity was associated with OSA severity in primary school-aged children only. Gender, socio-economic status and history of asthma and/or allergic rhinitis were not risk factors.Conclusions: Non-Caucasian ethnicity, paternal smoking and obesity in older children were associated with an increased risk of polysomnography-confirmed MS OSA in Australian children. [ABSTRACT FROM AUTHOR]

Aims To examine sleep study findings in children with Prader- Willi syndrome ( PWS) referred for polysomnography ( PSG) before commencement of growth hormone ( GH) and to evaluate the impact of sleep testing on treatment decisions. Methods The sleep unit database was used to identify all cases over an 8-year period (2003-2011). Standard overnight PSG was performed in the sleep laboratory. Obstructive sleep apnoea ( OSA) was defined by an obstructive apnoea-hypopnoea index >1/h. Age, symptoms of OSA, tonsillar size and body mass index ( BMI) Z-score were obtained through chart review. Results OSA was diagnosed in 15 of 34 (44%) cases identified. Those with OSA were significantly older ( P = 0.009) and more likely to have enlarged tonsils ( P = 0.05) than those without OSA. There was no difference in BMI Z-score or the presence of symptoms of OSA. GH was deferred in 13 (38%) pending treatment for OSA. Conclusions OSA was frequently present in children with PWS referred simply to meet the requirement for PSG before starting GH. OSA was more likely in older children and those with enlarged tonsils. GH treatment was deferred in 38% of cases. This study supports routine performance of PSG prior to GH, regardless of clinical history. [ABSTRACT FROM AUTHOR]

The authors discuss the issues concerning home ventilator support for children in Australia and New Zealand. They cites the lack of formal register or resources on the size of children cared with home ventilatory support and the lack of co-ordination of care for children in-need of invasive ventilatory support. They suggest the need of proper funding packages to support home care of children, carer support on children requiring ventilator, and regular audit on home ventilatory support.

Aim: International guidelines recommend that children who are managed at home with mechanical respiratory support (RS) should have sleep studies performed every 6–12 months. This recommendation is based on expert opinion, with little evidence to support it. No studies have been undertaken to examine the utility of sleep studies in children on RS. Methods: A retrospective review of sleep studies performed over a 12-month period was undertaken at a New Zealand paediatric sleep medicine referral centre, to determine changes made to RS following sleep studies. Results: Sixty-one sleep studies were performed for assessment of RS in 45 children (27 boys; median age 8.3 years; range 0.4–18.6 years). Twenty-nine (64%) children were on continuous positive airway pressure, 14 (31%) on bi-level non-invasive ventilation, and two (4%) on tracheostomy ventilation. A change was made to RS settings after 66% of studies. No clinical parameters predicted which children would require a change in settings. Conclusions: Although sleep studies are expensive and time-consuming, follow-up studies of children on RS provide important information for optimising management into the long term. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8-year-old children: The Childhood Asthma Prevention Study (CAPS)" in the August 2011 issue.