| E.1 Medical condition or disease under investigation | 
| E.1.1 | Medical condition(s) being investigated  | 
| Sleep-disordered breathing  | 
 
 
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| E.1.1.1 | Medical condition in easily understood language  | 
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| E.1.1.2 | Therapeutic area  | Psychiatry and Psychology [F] - Psychological processes [F02] | 
| MedDRA Classification | 
| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 20.0 | 
 
| E.1.2 | Level  | LLT | 
 
| E.1.2 | Classification code  | 10078294 | 
 
| E.1.2 | Term  | Obstructive sleep apnoea hypopnoea syndrome | 
 
| E.1.2 | System Organ Class  | 100000004855 | 
 
 
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| E.1.2 Medical condition or disease under investigation | 
| E.1.2 | Version  | 21.0 | 
 
| E.1.2 | Level  | LLT | 
 
| E.1.2 | Classification code  | 10040977 | 
 
| E.1.2 | Term  | Sleep apnoea | 
 
| E.1.2 | System Organ Class  | 100000004855 | 
 
 
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| E.1.3 | Condition being studied is a rare disease  |  Yes  | 
| E.2 Objective of the trial | 
| E.2.1 | Main objective of the trial  | 
| To assess the effect of Montelukast on neurocognition, specifically processing speed measured as Cancellation (Wechsler scales) and NIH toolbox processing speed. | 
 
 
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| E.2.2 | Secondary objectives of the trial  | 
•	To assess the effect of Montelukast on  -adenoid:nasopharynx size  -brain MRI -overnight oximetry, -symptoms of sleep-disordered breathing, e.g. snoring -sleep duration and  -Pain  •	To assess side-effects of Montelukast •	To assess feasibility of MRI in children aged 3-<8 years. 
 
 
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| E.2.3 | Trial contains a sub-study  |  No  | 
| E.3 | Principal inclusion criteria  | 
•	Aged between 3 and <8 years •	Informed consent with assent in accordance with institutional policies and European guidelines; ICF must be signed by patients/guardian  •	HbSS or HbSβ0 thalassaemia diagnosed by standard techniques (HPLC, IEF, MS or AlkE)  •	History of Sleep-Disordered Breathing, (i.e. parent-reported any degree of snoring (CHSQ questionnaire) and/or any abnormality on overnight oximetry compared with published data in children of the same age (e.g. nadir SO2<93%; mean SO2<96%)) •	In steady state i.e. haemoglobin not decreased by >10% in previous year, no painful crisis requiring opioids for at least 1 month and at least 1 month after any hospital admission •	Likely to comply with treatment for 3 months as determined by the local paediatrician or hematologist •	Able to speak and understand English  
 
 	
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| E.4 | Principal exclusion criteria | 
•	Other developmental or psychiatric disorders including craniofacial abnormalities, neuromuscular disorder and other chronic conditions. •	Patient already on montelukast •	Patient has had side effects on or an adverse reaction to montelukast in the past •	Presence or history of another hemoglobinopathy or blood dyscrasia •	Concomitant treatment with any other leukotriene antagonist within a window period of enrolment  •	Participation on other SCD/Montelukast trials 
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| E.5 End points | 
| E.5.1 | Primary end point(s) | 
The trial is powered to look at 2 primary outcomes 1. Cancellation (paper-and-pencil test of processing speed and attention from the Wechsler scales) 2. Processing speed on the NIH toolbox 
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| E.5.1.1 | Timepoint(s) of evaluation of this end point | 
| Baseline before treatment and after 12 weeks of treatment | 
 
 
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| E.5.2 | Secondary end point(s) | 
o	NIH toolbox executive function  o	Duration of Sleep from Children’s Sleep Habit questionnaire (CSHQ) o	Symptoms of Sleep Disordered Breathing from Pediatric Sleep questionnaire (PSQ) o	Pain burden from sickle module of PEDSQL o	AEs & drug side-effects 
 * Additional secondary endpoints in patients willing to undergo optional additional tests (MRI without sedation (awake/asleep); overnight oximetry): 
 o	Self-rated pain diaries via trial smartphone app o	Core MRI endpoints: Multiparametric maps (MPM) for adenoidal and brain size,   Volumetrics(T1 MRI), White matter integrity and structural connectivity (DWI),  
 *	Additional MRI endpoints if tolerated:  
 Perfusion (ASL),  Functional Connectivity (rsFMRI), Multiparametric maps (MPM), Oxygen-extraction fraction (TRUST) 
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| E.5.2.1 | Timepoint(s) of evaluation of this end point | 
| Baseline before treatment and after 12 weeks of treatment | 
 
 
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| E.6 and E.7 Scope of the trial | 
| E.6 | Scope of the trial | 
| E.6.1 | Diagnosis |  No  | 
| E.6.2 | Prophylaxis |  No  | 
| E.6.3 | Therapy |  Yes  | 
| E.6.4 | Safety |  Yes  | 
| E.6.5 | Efficacy |  Yes  | 
| E.6.6 | Pharmacokinetic |  No  | 
| E.6.7 | Pharmacodynamic |  No  | 
| E.6.8 | Bioequivalence |  No  | 
| E.6.9 | Dose response |  No  | 
| E.6.10 | Pharmacogenetic |  No  | 
| E.6.11 | Pharmacogenomic |  No  | 
| E.6.12 | Pharmacoeconomic |  No  | 
| E.6.13 | Others |  No  | 
| E.7 | Trial type and phase | 
| E.7.1 | Human pharmacology (Phase I) |  No  | 
| E.7.1.1 | First administration to humans |  No  | 
| E.7.1.2 | Bioequivalence study |  No  | 
| E.7.1.3 | Other |  No  | 
| E.7.1.3.1 | Other trial type description |  | 
| E.7.2 | Therapeutic exploratory (Phase II) |  Yes  | 
| E.7.3 | Therapeutic confirmatory (Phase III) |  Yes  | 
| E.7.4 | Therapeutic use (Phase IV) |  No  | 
| E.8 Design of the trial | 
| E.8.1 | Controlled |  Yes  | 
| E.8.1.1 | Randomised |  Yes  | 
| E.8.1.2 | Open |  No  | 
| E.8.1.3 | Single blind |  No  | 
| E.8.1.4 | Double blind  |  Yes  | 
| E.8.1.5 | Parallel group |  No  | 
| E.8.1.6 | Cross over  |  No  | 
| E.8.1.7 | Other |  No  | 
| E.8.2 |  Comparator of controlled trial | 
| E.8.2.1 | Other medicinal product(s) |  No  | 
| E.8.2.2 | Placebo  |  Yes  | 
| E.8.2.3 | Other |  No  | 
| E.8.2.4 | Number of treatment arms in the trial | 2 | 
| E.8.3 | 
                                The trial involves single site in the Member State concerned
                             |  Yes  | 
| E.8.4 |  The trial involves multiple sites in the Member State concerned  |  No  | 
| E.8.5 | The trial involves multiple Member States |  No  | 
| E.8.6 Trial involving sites outside the EEA | 
| E.8.6.1 | Trial being conducted both within and outside the EEA |  No  | 
| E.8.6.2 | Trial being conducted completely outside of the EEA |  No  | 
| E.8.7 | Trial has a data monitoring committee |  Yes  | 
| E.8.8 | 
                        Definition of the end of the trial and justification where it is not the last
                        visit of the last subject undergoing the trial
                     | 
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| E.8.9 Initial estimate of the duration of the trial | 
| E.8.9.1 | In the Member State concerned years | 2 | 
| E.8.9.1 | In the Member State concerned months | 3 | 
| E.8.9.1 | In the Member State concerned days | 31 | 
| E.8.9.2 | In all countries concerned by the trial years | 2 | 
| E.8.9.2 | In all countries concerned by the trial months | 3 | 
| E.8.9.2 | In all countries concerned by the trial days | 31 |