Heated humidified high flow nasal cannula therapy in children with obstructive sleep apnea: A randomized cross-over trial

Haley, Fishman; Al-Shamli, Nawal; Sunkonkit, Kanokkarn; Maguire, Brian J.; Selvadurai, Sarah; Baker, Adele; Amin, Reshma; Propst, Evan J.; Wolter, Nicholas E.; Eckert, Danny J.; Cohen, Eyal; Narang, Indra

doi:10.1016/j.sleep.2023.04.017

Cited by 9 publications

(6 citation statements)

References 59 publications

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“…Children with OSA who cannot tolerate the CPAP masks may benefit from HFNC treatment [74]. Pediatric OSA has been successfully treated with high-flow heated, humidified nasal air [28,[75][76][77]. Ten children (1-18 years) with obstructive sleep apnea determined to be CPAP-intolerant by their caregivers were included in a study by Hawkins et al Highflow humidified room air was initially delivered at rates of 5 to 15 L/min with pediatric or adult-sized cannulas and then gradually increased.…”

Section: High-flow Nasal Cannula Therapymentioning

confidence: 99%

Medical Treatment of Obstructive Sleep Apnea in Children

Ergenekon,

Gokdemir,

Ersu

2023

JCM

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Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1–4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children.

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Section: High-flow Nasal Cannula Therapymentioning

confidence: 99%

Medical Treatment of Obstructive Sleep Apnea in Children

Ergenekon,

Gokdemir,

Ersu

2023

JCM

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“…When compared with CPAP, HFNC demonstrates similar efficacy. A randomized cross-over trial performed by Fishman et al examined 18 children diagnosed with OSA, each of which completed both an HFNC titration study as well as a CPAP titration study in a randomized order [ 9 ]. They noted no significant difference in OAHI reduction from baseline with HFNC versus CPAP and suggest that as they have similar clinical benefits, HFNC may be a preferred option for children with poor CPAP adherence [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…While beneficial in treating OSA, CPAP therapy can pose significant challenges in adherence for children. Recent studies have demonstrated the role of high-flow nasal cannula (HFNC) in the treatment of OSA in infants and children [6][7][8][9]. In this case report, we discuss the evaluation and treatment of severe OSA in a child with NEHI and review the role of HFNC in the treatment of pediatric OSA.…”

Section: Introductionmentioning

confidence: 99%

Role of High Flow Nasal Cannula as a Novel Therapy for Treatment of Severe Obstructive Sleep Apnea in a Child With Neuroendocrine Hyperplasia of Infancy: A Case Report and Review of Literature

Feller,

Bickel,

Palani

et al. 2024

Cureus

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Neuroendocrine hyperplasia of infancy is a rare form of pediatric interstitial lung disease presenting with hypoxemia, tachypnea, retractions, and persistent pulmonary crackles in the first year of life. As these children frequently require supplemental oxygen therapy and demonstrate nighttime hypoxemia, there is a concern for an increased prevalence of sleep-disordered breathing in this population, including obstructive sleep apnea. As untreated sleep-disordered breathing is associated with adverse developmental outcomes for children, it is essential to promptly diagnose and treat. However, treatment of obstructive sleep apnea is often challenging in children. In this report, we describe a case of a child diagnosed with neuroendocrine hyperplasia of infancy at 12 months of age who was subsequently found to have severe obstructive sleep apnea that persisted despite adenotonsillectomy. As continuous positive airway pressure was not well tolerated, the patient was initiated on a high-flow nasal cannula at nighttime, which resulted in improvement of his sleep apnea and daytime functioning with better adherence to treatment. Our case illustrates the importance of screening for sleep-disordered breathing in patients with neuroendocrine hyperplasia of infancy, as well as the utility of a high-flow nasal cannula as a novel, effective treatment for pediatric obstructive sleep apnea.

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“…During HFNC therapy, gas is supplied at a constant flow rate, which does not adjust to maintain a certain pressure and pressure is not monitored. HFNC is effective in improving the oAHI in children with OSAS in the sleep laboratory [ 61 – 64 ]. A meta-analysis concluded that although limited numbers of heterogeneous and uncontrolled titration studies indicated that HFNC improves oAHI and oxygen saturation in children with OSAS, further research is needed on long-term efficacy and compliance with a focus on different age groups [ 65 ].…”

Section: Progress In Nonsurgical and Surgical Interventions For The M...mentioning

confidence: 99%

An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life

Polytarchou,

Moudaki,

Van de Perck

et al. 2024

Eur Respir Rev

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The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea–hypopnoea index >5 events·h−1may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.

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Heated humidified high flow nasal cannula therapy in children with obstructive sleep apnea: A randomized cross-over trial

Cited by 9 publications

References 59 publications

Medical Treatment of Obstructive Sleep Apnea in Children

Medical Treatment of Obstructive Sleep Apnea in Children

Role of High Flow Nasal Cannula as a Novel Therapy for Treatment of Severe Obstructive Sleep Apnea in a Child With Neuroendocrine Hyperplasia of Infancy: A Case Report and Review of Literature

An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life

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