A 6-year-old boy with Down syndrome (DS) has presented to the community paediatric clinic with a history consistent with obstructive sleep apnoea (OSA). Clinical examination reveals that he demonstrates mouth breathing and that his tonsils are enlarged. His parents are keen to explore non-surgical options. Should montelukast be commenced?

In school-aged children with DS (patient), does montelukast (intervention) reduce the severity of OSA (outcome)?

A comprehensive literature review was carried out using PubMed and Web of Science in August 2022. The following terms were used:

Title/Abstract: [leukotriene*]OR[montelukast]OR[anti-inflammatory]OR[anti inflammatory]

AND

Title/Abstract:[Trisomy 21]OR[Down syndrome]or[syndrome]

AND

Title/Abstract:[sleep disordered breathing]OR[sleep related breathing disorder]OR[obstructive sleep apnea/apnoea]

This search revealed 93 results. Titles and abstracts were reviewed. 91 articles were removed for the following reasons: unrelated to the clinical question (n=63), non-systematic review articles (n=18), expert opinion or guidelines (n=2), protocol only for a systematic review (n=1) and excluded children with DS (n=7). Two studies were ultimately included and summarised in table 1. A review of the bibliographies revealed two further potential studies, but these were removed after full-text review due to lack of relevance to the clinical question.

Summary of studies

OSA is more prevalent, severe and associated with poorer medical and neurocognitive outcomes in children with DS. Adenotonsillectomy is the primary …