High-flow nasal cannula ventilation therapy for obstructive sleep apnea in ischemic stroke patients requiring nasogastric tube feeding: a preliminary study

Abstract

Obstructive sleep apnea (OSA) is associated with increasing risk of recurrent stroke and mortality. Nasogastric tubes used by dysphagic stroke patients may interfere with nasal continuous positive airway pressure (CPAP) due to air leakage. This study was evaluated the effects and short-term tolerability of high-flow nasal cannula (HFNC) therapy for OSA in stroke patients with nasogastric intubation. The HFNC titration study was performed in post-acute ischemic stroke patients with nasogastric intubation and OSA. Then, participants were treated with HFNC therapy in the ward for one week. Eleven participants (eight males) who were all elderly with a median age of 72 (IQR 67-82) years and a body mass index of 23.5 (IQR 22.0-26.6) completed the titration study. The HFNC therapy at a flow rate up to 50~60 L/min significantly decreased the apnea-hypopnea index from 52.0 events/h (IQR 29.9-61.9) to 26.5 events/h (IQR 3.3-34.6) and the total arousal index from 34.6 (IQR 18.6-42.3) to 15.0 (IQR 10.3-25.4). The oxygen desaturation index was also significantly decreased from 53.0 events/h (IQR 37.0-72.8) to 16.2 events/h (IQR 0.8-20.1), accompanied by a significant improvement in the minimum SpO 2 level. Finally, only three participants tolerated flow rates of 50~60 L/minute in one-week treatment period. Conclusively, HFNC therapy at therapeutic flow rate is effective at reducing the OSA severity in post-acute ischemic stroke patients with nasogastric intubation. Owing to the suboptimal acceptance, HFNC might be a temporary treatment option, and CPAP therapy is suggested after the nasogastric tube is removed.

Effects of nasal high flow on nocturnal hypercapnia, sleep, and sympathovagal balance in patients with neuromuscular disorders

“…Finally, tolerability of NHF was potentially hampered by the fact that patients were confronted with this kind of ventilatory support for the first time. At the same time, low tolerability of NHF50 in particular is in line with one recent previous report on this in adult patients with obstructive sleep apnoea [ 44 ]. In contrast, all patients had started NIV substantially earlier including the opportunity to get used to it.…”

Reinforcement learning assisted oxygen therapy for COVID-19 patients under intensive care

“…In twenty-nine percent of the time, the patients received an oxygen flow close to the suggested rate within 5 L/min while forty-four percent of the time, the difference between the administered and suggested oxygen flow rates are within 10 L/min. Since the high‐flow nasal oxygen (HFNO) therapy often increases flow rate in increments of 10 L/min up to 60 L/min [ 28 ], it suggests that RL-oxygen is consistent with physicians about 40–50% of the time.

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Nocturnal nasal high-flow oxygen therapy in elderly patients with concomitant chronic obstructive pulmonary disease and obstructive sleep apnea

“…This is the first study on NHF on patients with overlap syndrome. Only few studies have previously explored the effect of nasal high-flow insufflation on upper airway obstruction [13,14,19,20]. In 2007, an early physiological study showed that in 11 patients with mild to moderate OSA a transnasal airflow of 20 L/min improved the AHI, which changed from average 28 to 10, and reduced the number of arousals/hour from 18 to 8, thus improving sleep quality [13].…”