High-flow nasal cannula for children not compliant with continuous positive airway pressure

Area of Science:

• Pediatric Pulmonology
• Sleep Medicine
• Respiratory Therapy

Background:

• Continuous positive airway pressure (CPAP) is a primary treatment for severe obstructive sleep apnea (OSA) in children.
• Poor patient compliance with CPAP therapy remains a significant challenge, limiting its long-term effectiveness.
• High-flow nasal cannula (HFNC) presents a potential alternative, but data on its efficacy and long-term compliance in pediatric OSA are limited.

Purpose of the Study:

• To evaluate the efficacy and objective long-term compliance of HFNC as an alternative treatment for pediatric patients with severe OSA who are non-compliant with CPAP.
• To assess the improvement in OSA parameters using HFNC in this patient population.

Main Methods:

• A study cohort included children aged 0-18 years with severe OSA (apnea-hypopnea index > 10 events/h) non-compliant with CPAP (<2 h/night use).
• HFNC therapy was initiated during outpatient visits.
• Outcomes measured included objective compliance (hours/night) after one month and OSA improvement via respiratory polygraphy (RP) with HFNC.

Main Results:

• Eight patients (mean age 8.9 years, mean AHI 33 events/h) were studied, including six with Down syndrome.
• After one month, 62% (five patients) achieved HFNC compliance of over 4 hours/night (mean 7h 10min).
• HFNC successfully corrected OSA in compliant patients (mean AHI 2 events/h with HFNC), but was not tolerated by three older Down syndrome patients.

Conclusions:

• HFNC can achieve good compliance and effectively treat OSA in selected children with OSA who are non-compliant with CPAP.
• HFNC may serve as a valuable rescue therapy for pediatric patients who do not adhere to CPAP treatment.