High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

Joseph, Leon; Goldberg, Shmuel; Shitrit, Michal; Picard, Elie

doi:10.5664/jcsm.5014

Cited by 58 publications

(43 citation statements)

References 22 publications

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“…Our protocol included sleep staging, sleep architecture, heart rate, and transcutaneous CO 2 monitoring, which has not been previously reported. Compared to a recent similar study 28 our population is larger in size and more homogeneous in age.…”

Section: Discussionmentioning

confidence: 66%

“…Though the long-term safety has not yet been studied, data thus far 19,22,23,28 suggest that treating OSA with HFNC has minimal risk and is likely preferable to non-adherence to CPAP. Whereas CPAP has been associated with impaired midface development due to pressure on the maxilla, 12 this nasal cannula is unlikely to cause similar adverse changes due to the open nasal prong design.…”

Section: Discussionmentioning

confidence: 99%

“…suggests dramatic improvement in cardiorespiratory function using HFNC therapy. McGinley et al 22,23 and Joseph et al 28 have demonstrated improvements in OSA with HFNC in children with non-FDA approved, experimental, or undisclosed devices. Our study highlights improvements in the AHI, especially the hypopnea index, and oxyhemoglobin saturation nadir using HFNC, in addition to improved mean saturation, desaturation index, and heart rate.…”

Section: Discussionmentioning

confidence: 99%

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High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Continuous positive airway pressure (CPAP) is effective but challenging for children with obstructive sleep apnea (OSA). High-flow air via open nasal cannula (HFNC) as treatment in children remains controversial. We report the efficacy of HFNC in children with OSA and CPAP intolerance, a titration protocol, and a discussion of potential mechanisms. Methods: Patients aged 1 to 18 years with OSA (defined by obstructive apnea-hypopnea index [OAHI] greater than 1 event/h) and CPAP intolerance were enrolled. Routine polysomnography data obtained during 1 night wearing HFNC was compared with diagnostic data by Wilcoxon rank-sum test. Results: Ten school-age subjects (representing all patients attempting HFNC at our institution to date) with varied medical conditions, moderate to severe OSA, and CPAP intolerance wore HFNC from 10 to 50 L/min of room air with oxygen supplementation if needed (room air alone for 6 of the 10). HFNC reduced median OAHI from 11.1 events/h (interquartile range 8.7-18.8 events/h) to 2.1 events/h (1.7-2.2 events/h; P = .002); increased oxyhemoglobin saturation (SpO2) mean from 91.3% (89.6% to 93.5%) to 94.9% (92.4% to 96.0%; P < .002); increased SpO2 nadir from 76.0% (67.3% to 82.3%) to 79.5% (77.2% to 86.0%; P = .032); decreased SpO2 desaturation index from 19.2 events/h (12.7-25.8 events/h) to 6.4 events/h (4.7-10.7 events/h; P = .013); and reduced heart rate from 88 bpm (86-91 bpm) to 74 bpm (67-81 bpm; P = .004). Stratified analysis of the 6 subjects with only room air via HFNC, the OAHI, obstructive hypopnea index, and mean SpO2 still demonstrated improvements (P = .031). Conclusions: High-flow nasal cannula reduces respiratory events, improves oxygenation, reduces heart rate, and may be effective for CPAP intolerant children with moderate to severe OSA. Our data suggest HFNC warrants further study and consideration by payers as OSA therapy.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

Hawkins

Huston

Campbell

et al. 2017

Journal of Clinical Sleep Medicine

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“…Nocturnal NPPV normalises the AHI and desaturation index, and improves inspiratory muscle synchrony [135,136]. Limited data support the use of high-flow nasal cannula therapy in children with nCPAP intolerance [137]. b) During periods of upper respiratory infection, nCPAP may be interrupted for a few days due to nasal obstruction and mouth leak [134].…”

Section: 5mentioning

confidence: 99%

ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

et al. 2017

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The present statement was produced by a European Respiratory Society Task Force to summarise the evidence and current practice on the diagnosis and management of obstructive sleep disordered breathing (SDB) in children aged 1-23 months. A systematic literature search was completed and 159 articles were summarised to answer clinically relevant questions. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are identified. Morbidity (pulmonary hypertension, growth delay, behavioural problems) and coexisting conditions (feeding difficulties, recurrent otitis media) may be present. SDB severity is measured objectively, preferably by polysomnography, or alternatively polygraphy or nocturnal oximetry. Children with apparent upper airway obstruction during wakefulness, those with abnormal sleep study in combination with SDB symptoms ( snoring) and/or conditions predisposing to SDB ( mandibular hypoplasia) as well as children with SDB and complex conditions ( Down syndrome, Prader-Willi syndrome) will benefit from treatment. Adenotonsillectomy and continuous positive airway pressure are the most frequently used treatment measures along with interventions targeting specific conditions ( supraglottoplasty for laryngomalacia or nasopharyngeal airway for mandibular hypoplasia). Hence, obstructive SDB in children aged 1-23 months is a multifactorial disorder that requires objective assessment and treatment of all underlying abnormalities that contribute to upper airway obstruction during sleep.

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“…Joseph et al reported their experience with the use of domiciliary high‐flow nasal cannula in a case series of five pediatric patients aged 2 months to 15 years with severe OSAS. They observed a dramatic improvement in clinical signs and PSG respiratory indices of OSAS in all patients.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Pulmonologyyear in review 2015: Part 2

Praud

2016

Pediatr Pulmonol.

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Pediatric Pulmonology covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review (Part 2) covers articles on sleep-disordered breathing. Pediatr Pulmonol. 2016;51:740-746. © 2016 Wiley Periodicals, Inc.

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High-Flow Nasal Cannula Therapy for Obstructive Sleep Apnea in Children

Cited by 58 publications

References 22 publications

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

High-Flow, Heated, Humidified Air Via Nasal Cannula Treats CPAP-Intolerant Children With Obstructive Sleep Apnea

ERS statement on obstructive sleep disordered breathing in 1- to 23-month-old children

Pediatric Pulmonologyyear in review 2015: Part 2

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