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High flow nasal cannula treatment for obstructive sleep apnea in infants and young children
Daniel Ignatiuk1, Britta Schaer2, Brian McGinley2
1Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
High-flow nasal cannula (HFNC) therapy effectively treats obstructive sleep apnea (OSA) in children, offering an alternative to continuous positive airway pressure (CPAP) with good home adherence.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Care
Background:
- Continuous positive airway pressure (CPAP) is the primary non-surgical treatment for pediatric obstructive sleep apnea (OSA).
- Limitations of CPAP include poor patient adherence and potential for midface hypoplasia.
- High-flow nasal cannula (HFNC) therapy is explored as an alternative treatment modality.
Purpose of the Study:
- To evaluate the efficacy of warm humidified air delivered via HFNC for treating pediatric OSA.
- To assess HFNC effectiveness in both sleep laboratory and home environments.
- To determine adherence and complication rates associated with HFNC therapy in children.
Main Methods:
- Retrospective review of children with OSA treated with HFNC.
- HFNC titration and diagnostic sleep studies were performed.
- Assessment of sleep architecture, arousals, apnea-hypopnea indices (AHI), adherence, and complications over 12 months.
Main Results:
- Twenty-two children with OSA underwent HFNC titration, showing a significant reduction in obstructive AHI (28.9 to 2.6 events/h).
- Nineteen patients received home HFNC; 16% achieved OSA resolution by 12 months.
- Of 12 patients with follow-up, 58% continued HFNC therapy, with cannula dislodgement being the most common complication.
Conclusions:
- High-flow nasal cannula (HFNC) serves as a viable treatment alternative for infants and young children with OSA.
- HFNC demonstrated good tolerability and effectiveness in the home setting for pediatric OSA management.
Background:
Continuous positive airway pressure (CPAP) is the nonsurgical treatment of choice for children with obstructive sleep apnea (OSA). However, CPAP limitations include difficulty with adherence and midface hypoplasia risk. We, therefore, sought to assess the effect of warm humidified air delivered via open nasal cannula (HFNC) on OSA in children in the sleep laboratory and at home.
Methods:
A retrospective review was performed among children recommended treatment of OSA with HFNC. Reasons for HFNC recommendation included poor surgical candidacy, residual OSA following surgery, and CPAP intolerance. Children underwent both diagnostic and HFNC titration sleep studies and were prescribed HFNC for home use. Standard sleep architecture, arousals, and apnea-hypopnea indices (AHI) were assessed with the evaluation of reported adherence and complications over 12 months of treatment.
Results:
Twenty-two children (average 12.8 months, 95% confidence interval [95% CI: 7.0, 18.6]) with OSA (obstructive AHI [OAHI] range: 4.8-89.2 events/h) underwent HFNC titration with significant reduction in OAHI (28.9 events/h [17.6, 40.2] vs 2.6 [1.1, 4.0]; P < .001) (mean [95% CI]). Nineteen patients received home HFNC treatment. By 12 months, four patients were lost to follow-up and OSA resolved in three patients (16%). Of 12 remaining patients, 7 (58%) continued therapy while 5 (42%) discontinued due to intolerance. The most common treatment complication was cannula dislodgement. Additional complications included skin irritation, dry mucus membranes, restlessness, oxygen desaturation, and increased central apneas.
Conclusion:
HFNC offers a treatment alternative to CPAP in infants and young children with OSA and was well tolerated at home in our study.
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