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Updated: Sep 18, 2025
Multi-Modal Home Sleep Monitoring in Older Adults
Published on: January 26, 2019
Efficacy of high-flow nasal cannula therapy and its effectiveness in home settings for paediatric obstructive sleep
Kate C Chan1, Chun T Au2, Ka L Kwok3
1Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China.
Insights
High-flow nasal cannula (HFNC) therapy shows comparable efficacy to continuous positive airway pressure (CPAP) for moderate-to-severe obstructive sleep apnoea in children. However, HFNC did not improve adherence or behavioural outcomes compared to CPAP.
Area of Science:
- Pediatric Pulmonology
- Sleep Medicine
- Respiratory Care
Background:
- Continuous positive airway pressure (CPAP) adherence is a significant challenge for pediatric patients with obstructive sleep apnoea (OSA).
- Alternative treatment options are needed for moderate-to-severe OSA (MS-OSA) in children and adolescents.
Purpose of the Study:
- To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy as an alternative to CPAP in pediatric MS-OSA.
- To compare adherence, quality of life, and behavioral outcomes between HFNC and CPAP in this population.
Main Methods:
- Children and adolescents with MS-OSA underwent overnight titration studies with both HFNC and CPAP.
- A 6-month intervention trial compared self-reported adherence, quality of life (OSA-18), daytime sleepiness, and behavioral measures between HFNC and CPAP groups.
Main Results:
- Both HFNC and CPAP significantly reduced the obstructive apnoea-hypopnoea index (OAHI), with no significant difference in residual OAHI between the two therapies (p=0.281).
- CPAP adherence was significantly better than HFNC adherence.
- Quality of life scores (OSA-18) improved with both treatments, but daytime sleepiness and behavioral measures did not show significant improvement.
Conclusions:
- HFNC is a viable alternative treatment for pediatric MS-OSA, demonstrating comparable efficacy to CPAP in reducing disease severity.
- Despite comparable efficacy, HFNC did not lead to improved self-reported adherence or behavioral outcomes compared to CPAP in children and adolescents.
Background And Objectives:
Adherence to continuous positive airway pressure (CPAP) remains a major issue for children and adolescents with obstructive sleep apnoea (OSA). Hence, there is a demand for alternative treatment options. This study aimed to investigate the efficacy of high-flow nasal cannula (HFNC) therapy in children with moderate-to-severe OSA (MS-OSA) and to investigate adherence, quality of life and behavioural measures with HFNC compared to CPAP.
Methods:
Children and adolescents with MS-OSA underwent titration studies with HFNC and CPAP on two consecutive nights. The efficacy of HFNC in treating MS-OSA, determined by the residual obstructive apnoea-hypopnoea index (OAHI) with the device, was compared to CPAP. Eligible participants underwent a 6-month interventional trial with HFNC and CPAP to compare self-reported adherence, quality of life, and behavioural measures.
Results:
Twenty-nine participants (90 % male) with a mean ± SD age of 12.8 ± 3.0 years completed the titration studies. The mean residual OAHI with HFNC and CPAP was 5.4 ± SD 12.6 and 3.59 ± SD 7.8 events/h respectively (p = 0.281). The mean [95 % confidence interval] reductions in OAHI with HFNC and CPAP were -7.2 [-9.2, -5.1] vs. -9.0 [-12.2, -5.9] respectively. Twenty-two participants underwent the intervention study. Overall, adherence to CPAP was significantly better than that to HFNC therapy. Significant improvement in OSA-18 scores was observed with both HFNC and CPAP, but not in daytime sleepiness and behavioural measures.
Conclusions:
HFNC is an alternative treatment option with comparable efficacy to CPAP in alleviating disease severity in paediatric patients with MS-OSA. However, self-reported adherence and behavioural outcomes were not improved with HFNC therapy compared to CPAP.
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