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Heated humidified high flow nasal cannula therapy in children with obstructive sleep apnea: A randomized cross-over
Haley Fishman1, Nawal Al-Shamli2, Kanokkarn Sunkonkit3
1The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.
Insights
Heated high-flow nasal cannula (HFNC) therapy offers a comparable alternative to continuous positive airway pressure (CPAP) for treating moderate-to-severe obstructive sleep apnea (OSA) in children with obesity and medical complexity. Both therapies significantly reduced apnea/hypopnea index and improved oxygen saturation.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Care
Background:
- Obstructive sleep apnea (OSA) is common in children with obesity and medical complexity.
- Adenotonsillectomy is often ineffective, and continuous positive airway pressure (CPAP) adherence can be poor.
- Heated high-flow nasal cannula (HFNC) therapy is a potential alternative with possibly better adherence.
Purpose of the Study:
- To compare the efficacy of HFNC and CPAP in treating moderate-to-severe OSA in children.
- To evaluate changes in the apnea/hypopnea index (OAHI) as the primary outcome.
Main Methods:
- A single-blinded, randomized, two-period crossover trial involving 18 children (aged 2-18 years) with moderate-to-severe OSA.
- Participants underwent both HFNC and CPAP titration studies in a random order.
- Polysomnography was used to measure OSA severity.
Main Results:
- Both HFNC and CPAP showed comparable reductions in OAHI (mean reduction of -19.8 vs. -18.8 events/hour).
- Improvements in nadir oxygen saturation, oxygen desaturation index, and sleep efficiency were similar between the two therapies.
- No statistically significant differences were found between HFNC and CPAP for the primary or secondary outcomes.
Conclusions:
- HFNC and CPAP therapy provide similar efficacy in reducing polysomnography-measured OSA severity in children with obesity and medical complexities.
- HFNC may be a viable alternative to CPAP, potentially improving adherence in this population.
Objective/Background:
Moderate-to-severe obstructive sleep apnea (OSA) is highly prevalent in children with obesity and/or underlying medical complexity. The first line of therapy, adenotonsillectomy (AT), does not cure OSA in more than 50% of these children. Consequently, continuous positive airway pressure (CPAP) is the main therapeutic option but adherence is often poor. A potential alternative which may be associated with greater adherence is heated high-flow nasal cannula (HFNC) therapy; however, its efficacy in children with OSA has not been systematically investigated. The study aimed to compare the efficacy of HFNC with CPAP to treat moderate-to-severe OSA with the primary outcome measuring the change from baseline in the mean obstructive apnea/hypopnea index (OAHI).
Participants/Methods:
This was a single-blinded randomized, two period crossover trial conducted from March 2019 to December 2021 at a Canadian pediatric quaternary care hospital. Children aged 2-18 years with obesity and medical complexity diagnosed with moderate-to-severe OSA via overnight polysomnography and recommended CPAP therapy were included in the study. Following diagnostic polysomnography, each participant completed two further sleep studies; a HFNC titration study and a CPAP titration study (9 received HFNC first, and 9 received CPAP first) in a random 1:1 allocation order.
Results:
Eighteen participants with a mean ± SD age of 11.9 ± 3.8 years and OAHI 23.1 ± 21.7 events/hour completed the study. The mean [95% CI] reductions in OAHI (-19.8[-29.2, -10.5] vs. -18.8 [-28.2, -9.4] events/hour, p = 0.9), nadir oxygen saturation (7.1[2.2, 11.9] vs. 8.4[3.5, 13.2], p = 0.8), oxygen desaturation index (-11.6[-21.0, -2.3] vs. -16.0[-25.3, -6.6], p = 0.5) and sleep efficiency (3.5[-4.8, 11.8] vs. 9.2[0.9, 15.5], p = 0.2) with HFNC and CPAP therapy were comparable between conditions.
Conclusion:
HFNC and CPAP therapy yield similar reductions in polysomnography quantified measures of OSA severity among children with obesity and medical complexities.
Trial Registration:
NCT05354401 ClinicalTrials.gov.
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