Effect of a high-flow open nasal cannula system on obstructive sleep apnea in children.
OBJECTIVE
Obstructive sleep apnea syndrome in children is associated with significant morbidity. Continuous positive airway pressure (CPAP) treats obstructive apnea in children, but is impeded by low adherence. We, therefore, sought to assess the effect of warm humidified air delivered through an open nasal cannula (treatment with nasal insufflation [TNI]) on obstructive sleep apnea in children with and without adenotonsillectomy.


METHODS
Twelve participants (age: 10 +/- 1 years; BMI: 35 +/- 14 kg/m(2)), with obstructive apnea-hypopnea syndrome ranging from mild to severe (2-36 events per hour) were administered 20 L/min of air through a nasal cannula. Standard sleep architecture, sleep-disordered breathing, and arousal indexes were assessed at baseline, on TNI, and on CPAP. Additional measures of the percentage of time with inspiratory flow limitation, respiratory rate, and inspiratory duty cycle were assessed at baseline and on TNI.


RESULTS
TNI reduced the amount of inspiratory flow limitation, which led to a decrease in respiratory rate and inspiratory duty cycle. TNI improved oxygen stores and decreased arousals, which decreased the occurrence of obstructive apnea from 11 +/- 3 to 5 +/- 2 events per hour (P < .01). In the majority of children, the reduction in the apnea-hypopnea index on TNI was comparable to that on CPAP.


CONCLUSIONS
TNI offers an alternative to therapy to CPAP in children with mild-to-severe sleep apnea. Additional studies will be needed to determine the efficacy of this novel form of therapy.
McGinley
Brian
B
Division of Pediatric Pulmonology, Johns Hopkins Pediatric Sleep Disorders Center, Johns Hopkins University, Baltimore, Maryland, USA. bmcginley@jhmi.edu
Halbower
Ann
A
Schwartz
Alan R
AR
Smith
Philip L
PL
Patil
Susheel P
SP
Schneider
Hartmut
H
D000293:Adolescent; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D045422:Continuous Positive Airway Pressure; D004867:Equipment Design; D005260:Female; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods; D008297:Male; D009296:Nasal Cavity; D017286:Polysomnography; D012138:Respiratory Therapy / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome