Summary of findings for the main comparison. Corticosteroids compared to placebo for obstructive sleep apnoea in children.
| Corticosteroids compared to placebo for obstructive sleep apnoea in children | ||||||
| Patient or population: obstructive sleep apnoea in children Setting: outpatients Intervention: corticosteroids Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with corticosteroids | |||||
| AHI (number of breathing pauses and episodes of shallow breathing per hour of sleep time) assessed with: polysomnography follow‐up: mean 12 weeks | The mean AHI was 5.18 per hour | MD 3.18 per hour lower (8.70 lower to 2.35 higher) | ‐ | 75 (2 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | |
| Desaturation index (number of times per hour of sleep time that the blood's O₂ level drops by a certain proportion from baseline) assessed with: polysomnography follow‐up: mean 12 weeks | The mean desaturation index was 3.0 per hour | MD 2.12 per hour lower (4.27 lower to 0.04 higher) | ‐ | 75 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 2 | |
| Respiratory arousal index (number of times per hour of sleep time that an increased respiratory effort without a decrease in oxygen saturation is recorded) assessed with: polysomnography follow‐up: mean 12 weeks | The mean respiratory arousal index was 7.38 per hour | MD 0.71 per hour lower (6.25 lower to 4.83 higher) | ‐ | 75 (2 RCTs) | ⊕⊕⊝⊝ LOW 3 4 | |
| Nadir SpO₂ (lowest SpO₂ during sleep) assessed with: polysomnography follow up: mean 12 weeks | The mean nadir SpO₂ was 88.24% | MD 0.59% higher (1.09 lower to 2.27 higher) | ‐ | 75 (2 RCTs) | ⊕⊕⊕⊝ MODERATE 2 | |
| Serious adverse events (N experiencing events) | No serious adverse events reported. The following unintended effects were reported: nasal bleeding (4), nasal discomfort (1), diarrhoea (1) | No serious adverse events reported. The following unintended effects were reported: nasal bleeding (3), nasal discomfort (1), throat discomfort (1), vomiting (1) | ||||
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). AHI: Apnoea/hypopnoea index; CI: Confidence interval; SpO₂: oxygen saturation | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
1 Point estimates vary considerably across studies, very little overlap between confidence intervals, P = 0.10 for heterogeneity, I² = 63%. Downgraded once for inconsistency of results.
2 Upper boundary of 95% confidence interval suggests potential for negative effect of the treatment on the outcome. Downgraded once for imprecision.
3 Point estimates vary considerably across studies, very little overlap between confidence intervals, P = 0.06 for heterogeneity, I² = 72%. Downgraded once for imprecision.
4 Point estimate indicates no clinically significant effect with wide confidence intervals. Downgraded once for imprecision.