2015 HSC Section 1 Book of Articles

side effects and the overall favorable safety profile asso- ciated with the use of either ICS 36-38 or OM 39 and the possibility that based on the current encouraging results reported herein ICS 1 OM may ultimately replace T&A as the first line of treatment in mild OSA, provides major impetus for future, large-scale, multicenter RCTs. In summary, the retrospective analysis of our clinical experience associated with the implementation of ICS and OM in the management of mild OSA in children as an alternative to T&A is highly encouraging and sup- ports prospective evaluation of this treatment modality as a potential alternative to T&A.

of adherence to ICS 1 OM treatment, since no over- sight of adherence was implemented in this clinical population. There are multiple methodologic limitations that pre- clude assertive affirmations on the efficacy of ICS 1 OM treatment in mild pediatric OSA. The retrospective nature of the study and the uncontrolled and open-label approach that are inherent to the clinical practice set- ting in which ICS 1 OM was administered markedly reduce the level of evidence and of the strength of potential recommendations that can be derived from this study. 34,35 Nevertheless, the absence of significant

Acknowledgments Author contributions: D. G. had full access to all of the data in the study and takes respon- sibility for the integrity of the data and the accuracy of the data analysis. L. K.-G. was principal author of the manuscript. L. K.-G. and D. G. contributed to the conceptual framework for the study; L. K.-G. and D. G. contributed to data analysis; L. K.-G., R. B., and H. P. R. B. contributed to data acquisi- tion; L. K.-G., R. B., H. P. R. B., and D. G. contributed to data interpretation; L. K.-G. drafted the initial manuscript; R. B. and H. P. R. B. contributed to the revision of the manuscript; D. G. provided critical editing of the initial manuscript; D. G. is responsible for the financial support of the project; and L. K.-G., R. B., H. P. R. B., and D. G. approved the final manuscript. Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Kheirandish- Gozal is the recipient of an investigator- initiated grant from Merck & Co Inc on the effect of montelukast in the treatment of pediatric sleep apnea. Dr Gozal is the recipi- ent of an investigator-initiated grant from ResMed Corp on urine biomarkers in adult sleep apnea. Drs Bhattacharjee and Bandla have reported that no potential conflicts of interest exist with any companies/organiza- tions whose products or services may be discussed in this article. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. References 1. Marcus CL, Brooks LJ, Draper KA, et al; American Academy of Pediatrics. Diagnosis and management of child- hood obstructive sleep apnea syndrome. Pediatrics . 2012;130(3):e714-e755. 2. Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy

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