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High flow nasal cannula treatment for obstructive sleep apnea in infants and young children
Author(s) -
Ignatiuk Daniel,
Schaer Britta,
McGinley Brian
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25009
Subject(s) - medicine , nasal cannula , continuous positive airway pressure , polysomnography , obstructive sleep apnea , anesthesia , sleep apnea , apnea , sleep study , pediatrics , surgery , cannula
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.