Nowadays, parents pay more attention to children’s snoring and breath-holding at night. In the past, the treatment was mainly surgical removal of the enlarged adenoid tonsils, but this year, nasal hormones were gradually applied in the clinic to achieve certain efficacy, so I wrote a paper to summarize the experience in this area. I. Information and methods 1. Retrieval strategy The relevant literature was retrieved by computer search of Pubmed database, China Biomedical Literature CD-ROM database ( CBMdisc), China Knowledge Network full-text database (CNKI) and other Chinese and English databases, and combined with literature tracing and online query ( www.metstr.com; www.cnki.net) to obtain the full text. All relevant randomized controlled studies, case-control studies, or cohort studies from January 2000 to August 2014 were searched in the domestic and international literature. The Chinese search terms were “children”, “sleep apnea”, “snoring”, “breathing disorders”, “adenoids”, and “sleep apnea”. “adenoids”, “nasal hormone”, “budesonide”, “mometasone furoate”. “beclomethasone”, “fluticasone”; English search terms are “children”, “sleep apnea “, “sleep disorder”, “snoring”, “adenoid/adenoidal “, “nasal”, “intranasal” “corticosteroid”, “steroid”, “Glucocorticoid”, “fluticasone”, ” mometasone”, “budesonide”, “beclomethasone”. 2, offering inclusion criteria (1) Study type According to the Oxford Center for Evidence-Based Medicine evidence grading criteria for studies in the treatment and adverse effects category, multiple randomized controlled systematic evaluations and single large sample randomized controlled trials were preferred; followed by systematic evaluations of cohort studies and single cohort studies, and case-control studies, in decreasing steps. In this paper, we select all randomized controlled studies, case-control studies or cohort studies in Chinese and English that were published publicly between January 1, 2000 and August 31, 2014 and provided original data; the main purpose of the study was nasal hormone treatment of OSAHS in children. 3. study subjects (1) Patients were diagnosed with OSAHS in children by polysomnography (PSG) before surgery, and postoperative application of (2) Patients had no other systemic diseases, no history of upper respiratory tract infection, acute tonsillitis and other acute diseases within 1 month before treatment, no history of hormone application within 1 month, and no history of hormone allergy; (3) Patients were less than 18 years old, and nationality, gender and origin were not restricted. 4. Interventions Nasal hormone therapy was applied, including budesonide, mometasone furoate, beclomethasone, fluticasone and other nasal hormones. 5. Observation index The apnea hypopnea index (AHI) was used as an objective evaluation index. 6. Exclusion criteria (1) studies with simultaneous combination of medications; (2) literature with lower grading of clinical evidence such as case reports, empirical summaries, theoretical discussions, reviews, abstracts, etc.; (3) literature with assessment time less than 1 month or more than 10% of missed visits; (4) literature that cannot provide valid experimental data; (5) literature published earlier or with smaller sample size in repeated trials; 7. and data extraction The primary screening was performed by reading the titles and abstracts of the literature, while the secondary screening was performed by reading the full text later, and the final decision on whether the literature was included was based on the inclusion criteria. Relevant information was extracted for each included literature: first author, year, mean age, sample size, treatment protocol, follow-up time, and other information were extracted. The data were checked several times to ensure accuracy. The above process was done independently by two investigators, and differences in opinion were resolved by discussion or assistance from a third investigator. (1) Statistical analysis methods Meta-analysis software Review Manager 5.3.4 was used for calculations, and weighted mean difference (WMD) was used for continuous variables, and effect sizes were expressed as 95% CI and plotted as forest plots, with differences considered statistically significant at P < 0.05. The included trials were tested for heterogeneity, and if the heterogeneity test suggested no significant heterogeneity, the fixed-effects model was used; otherwise, further analysis of the causes was required, and if the clinical conditions were consistent across the included trials, the random-effects model was selected. If there was significant clinical heterogeneity in the study, only descriptive studies were done. II. RESULTS 1. Results of literature examination and evaluation A total of 43 English-language and 21 Chinese-language papers were examined, of which a total of 23 were likely to meet the inclusion criteria. After further reading of the full text, 13 of the English literature were excluded, of which 8 did not apply PSG examination, 3 studied adults, and 2 were reviews. 11 Chinese literature were all excluded because no PSG examination was performed. Three English-language papers were included [6-8], two of which were randomized controlled double-blind studies and one of which was a case-control study. A total of 88 study subjects were involved. 2. general patient information and treatment modalities The following table shows the general profile of patients in the three studies. The age of the patients was concentrated between 3 and 9 years. One [6] was treated with fluticasone and two [7, 8] with budesonide for a treatment period of 4-6 weeks. All three studies reviewed short-term efficacy at 6 weeks after the start of treatment, one [7] performed a second review at 8 weeks after the end of treatment, and the other [8] reviewed medium- and long-term efficacy at 9 months after the end of treatment. 3, Efficacy analysis The graph shows I2=98%, indicating a relatively significant heterogeneity between studies, and the results indicate a significant change in weighted mean AHI after treatment [WMD = 4.07, 95% CI (0.00,8.14), P<0.00001]. Combined with the fact that all three studies suggested a statistically significant (p<0.05) decrease in mean AHI in patients after treatment, nasal hormone therapy was considered effective. Further analysis of the large variability in heterogeneity among the studies may be related to the different degrees of disease in the selected patients. brouillette et al [6] selected patients based on the criteria of children with OSAHS, and the more severely ill children with OSAHS clinically have a stronger need for treatment, so the mean preoperative AHI in this group was (10.7 ± 2.6) times/h. Kheirandish- Gozal et al [7] explicitly selected children with mild OSAHS (3.7±0.3) times/h for their study, while the case of Alexopoulos et al [8] excluded patients with AHI >10 times/h, so the mean preoperative AHI was (5.2+2.2) times/h, with a degree of disease between the two studies mentioned above. It also suggests that nasal hormones may be effective in mild, moderate and severe pediatric OSAHS patients. Kheirandish-Gozal et al [7] found that at the end of treatment, 26 (54.1%) of 48 participating children with OSAHS achieved clinical cure, i.e., AHI <1, and the remaining cases showed varying degrees of reduction. In a study by Brouillette et al [6], 46% of the hormone group and 75% of the control group opted for surgical treatment after nasal hormone treatment. The main side effects of nasal hormone application were rhinorrhea, diarrhea and or with vomiting [7, 8], but none of the treatment was discontinued due to mild symptoms. III. Discussion Adenoid hypertrophy is one of the main causes of OSAHS in children [1], and adenoid hypertrophy is partly physiological, while more often due to factors such as recurrent upper respiratory tract infections and the presence of allergic diseases in children.Modrzynski et al [9] found that 40.4% of children with allergic diseases such as allergic rhinitis and asthma had adenoid hypertrophy, so children OSAHS patients are mostly associated with nasal symptoms such as nasal obstruction, runny nose, and sneezing. In 1995, Demain et al [10] reported that the treatment of adenoid hypertrophy with nasal hormones could significantly reduce the size of adenoids, and since then, related studies have been conducted. In 2009, Kheirandish-Gozal et al [12] found that in vitro, hormones such as budesonide, fluticasone, and dexamethasone inhibited the proliferation of excised tonsils and adenoids in children with OSAHS. In 2011, Esteitie et al [13] grouped 24 pediatric OSAHS patients preoperatively, 13 patients were treated with fluticasone for 2 weeks, and 11 patients served as the control group, and the resected adenoids were examined postoperatively, and the results showed that pro-inflammatory cytokines and interleukin 6 were significantly (P < 0.05) reduced in the adenoids of the hormone group compared to the control group. The results showed that pro-inflammatory cytokines and interleukin 6 were significantly reduced in the adenoids of the hormone group compared with the control group (P < 0.05), indicating that nasal hormones have a clear anti-inflammatory effect on adenoid tissue. These studies suggest the feasibility of nasal hormone treatment for adenoid hypertrophy. Although the current application of nasal hormones for the treatment of OSAHS in children has obvious short-term efficacy, there are many problems: 1. A fixed treatment plan has not yet been formed, and there are currently more drug choices, such as mometasone furoate, budesonide and beclomethasone propionate. The duration of treatment with various hormones or the same hormone varies with each dosage [3, 6-8]; 2. Indication problems, all the above-mentioned studies had some patients with ineffective treatment or limited efficacy [6-8]. However, the investigators did not give specific explanations, indicating that the current study grouping is relatively crude and does not fully consider the effects of palatal tonsil size, jaw development, allergic rhinitis, and body mass index on treatment outcomes, such as the meta-analysis article published by Costa [14] in 2009, which showed that tonsil adenoidectomy was less effective in treating obese pediatric OSAHS patients, indicating that body mass index Brouillette et al [6] also showed that 46% of children chose surgery even after nasal hormone treatment, indicating that nasal hormones can only reduce or only short-term reduce OSAHS symptoms, and eventually patients will still be treated surgically; 3. The problem of efficacy maintenance, as Kheirandish-Gozal [7] reported that the efficacy can at least last for at least 8 weeks, but how beyond 8 weeks is an unknown, and long-term follow-up data are lacking. IV.CONCLUSIONS Limited data suggest that nasal hormones may improve clinical symptoms in pediatric OSAHS patients, but the sample sizes of the studies are currently small. There is a lack of high-quality, multicenter randomized clinical controlled trials and long-term efficacy observations, so the conclusions are of limited persuasiveness and need further study.