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Sleep and Breathing

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18-06-2021 | Sleep Apnea | Sleep Breathing Physiology and Disorders • Original Article

High-flow nasal cannula compared with continuous positive airway pressure in the treatment of obstructive sleep apnea

Authors: Chung-Chieh Yu, Chih-Yu Huang, Chung-Ching Hua, Huang-Pin Wu

Published in: Sleep and Breathing | Issue 2/2022

Abstract

Purpose

Continuous positive airway pressure (CPAP) is a standard treatment for obstructive sleep apnea (OSA). However, CPAP has limitations. High-flow nasal cannula (HFNC) is already in use for various types of respiratory diseases. As HFNC generates positive airway pressure, it may be a potential candidate for OSA treatment. This prospective study compared the therapeutic effects of HFNC to CPAP in patients with OSA.

Methods

Patients whose apnea–hypopnea index (AHI) was > 5 events/h were enrolled in this study. All participants were randomly divided into two groups. The first group underwent CPAP the first night and HFNC the second night. Conversely, the second group received HFNC the first night and CPAP the second night. Their respiratory events and sleep quality were compared using baseline polysomnography, CPAP, and HFNC.

Results

In total, 28 participants completed this study. Median [interquartile range] AHI (35.0 [20.0–48.6] vs. 10.8 [5.5–20.6] events/h; p < 0.001) was significantly improved by the HFNC. However, sleep quality was not improved. When CPAP was compared directly with HFNC, CPAP demonstrated a more favorable effect for respiratory events (AHI 5.0 [2.0–7.0] vs. 10.8 [5.5–20.6] events/h; p < 0.001) and sleep efficiency (88.1 [79.9–92.5] vs. 77.9 [69.2–86.6] %; p = 0.001).

Conclusion

The efficacy of CPAP was superior to HFNC for both respiratory events and sleep quality.

Trial registration

ClinicalTrials.gov Identifier: NCT03843372; URL: www.clinicaltrials.gov; Date of registration: November 2, 2019

Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, Hamilton GS, Dharmage SC (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34:70–81. https://doi.org/10.1016/j.smrv.2016.07.002CrossRefPubMed

Young T, Blustein J, Finn L, Palta M (1997) Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 20(8):608–613CrossRefPubMed

Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Nieto FJ, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 163(1):19–25. https://doi.org/10.1164/ajrccm.163.1.2001008CrossRefPubMed

Kakkar RK, Berry RB (2007) Positive airway pressure treatment for obstructive sleep apnea. Chest 132(3):1057–1072. https://doi.org/10.1378/chest.06-2432CrossRefPubMed

Ballester E, Badia JR, Hernandez L, Carrasco E, de Pablo J, Fornas C, Rodriguez-Roisin R, Montserrat JM (1999) Evidence of the effectiveness of continuous positive airway pressure in the treatment of sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(2):495–501. https://doi.org/10.1164/ajrccm.159.2.9804061CrossRefPubMed

Milleron O, Pilliere R, Foucher A, de Roquefeuil F, Aegerter P, Jondeau G, Raffestin BG, Dubourg O (2004) Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. Eur Heart J 25(9):728–734. https://doi.org/10.1016/j.ehj.2004.02.008CrossRefPubMed

Ferini-Strambi L, Marelli S, Galbiati A, Castronovo C (2013) Effects of continuous positive airway pressure on cognitition and neuroimaging data in sleep apnea. Int J Psychophysiol 89(2):203–212. https://doi.org/10.1016/j.ijpsycho.2013.03.022CrossRefPubMed

McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159(4 Pt 1):1108–1114. https://doi.org/10.1164/ajrccm.159.4.9807111CrossRefPubMed

Hui DS, Choy DK, Li TS, Ko FW, Wong KK, Chan JK, Lai CK (2001) Determinants of continuous positive airway pressure compliance in a group of Chinese patients with obstructive sleep apnea. Chest 120(1):170–176CrossRefPubMed

10.

McGinley BM, Patil SP, Kirkness JP, Smith PL, Schwartz AR, Schneider H (2007) A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med 176(2):194–200. https://doi.org/10.1164/rccm.200609-1336OCCrossRefPubMedPubMedCentral

11.

Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira JP, Argaud L, Chakarian JC, Ricard JD, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin JM, Tonnelier JM, Pierrot M, Mathonnet A, Beduneau G, Deletage-Metreau C, Richard JC, Brochard L, Robert R, Group FS, Network R (2015) High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 372(23):2185–2196. https://doi.org/10.1056/NEJMoa1503326CrossRef

12.

Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF (2011) Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth 107(6):998–1004. https://doi.org/10.1093/bja/aer265CrossRefPubMed

13.

Groves N, Tobin A (2007) High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care 20(4):126–131. https://doi.org/10.1016/j.aucc.2007.08.001CrossRefPubMed

14.

Berry RB, Brooks R, Gamaldo C, Harding SM, Lloyd RM, Quan SF, Troester MT, Vaughn BV (2017) AASM scoring manual updates for 2017 (version 2.4). J Clin Sleep Med 13(5):665–666. https://doi.org/10.5664/jcsm.6576CrossRefPubMedPubMedCentral

15.

Yang GG, Yang MC, Chung CY, Chen YT, Chang ET (2011) Respiratory-inductive-plethysmography-derived flow can be a useful clinical tool to detect patients with obstructive sleep apnea syndrome. J Formos Med Assoc 110(10):642–645. https://doi.org/10.1016/j.jfma.2011.08.006CrossRefPubMed

16.

Kogan D, Jain A, Kimbro S, Gutierrez G, Jain V (2016) Respiratory inductance plethysmography improved diagnostic sensitivity and specificity of obstructive sleep apnea. Respir Care 61(8):1033–1037. https://doi.org/10.4187/respcare.04436CrossRefPubMed

17.

Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172CrossRefPubMedPubMedCentral

18.

Kushida CA, Chediak A, Berry RB, Brown LK, Gozal D, Iber C, Parthasarathy S, Quan SF, Rowley JA, Task PAPT, F, American Academy of Sleep M, (2008) Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 4(2):157–171CrossRefPubMed

19.

Heinzer RC, Stanchina ML, Malhotra A, Jordan AS, Patel SR, Lo YL, Wellman A, Schory K, Dover L, White DP (2006) Effect of increased lung volume on sleep disordered breathing in patients with sleep apnoea. Thorax 61(5):435–439. https://doi.org/10.1136/thx.2005.052084CrossRefPubMedPubMedCentral

20.

Younes M (2004) Role of arousals in the pathogenesis of obstructive sleep apnea. Am J Respir Crit Care Med 169(5):623–633. https://doi.org/10.1164/rccm.200307-1023OCCrossRefPubMed

21.

Nilius G, Wessendorf T, Maurer J, Stoohs R, Patil SP, Schubert N, Schneider H (2010) Predictors for treating obstructive sleep apnea with an open nasal cannula system (transnasal insufflation). Chest 137(3):521–528. https://doi.org/10.1378/chest.09-0357CrossRefPubMed

Title: High-flow nasal cannula compared with continuous positive airway pressure in the treatment of obstructive sleep apnea
Authors: Chung-Chieh Yu
Chih-Yu Huang
Chung-Ching Hua
Huang-Pin Wu
Publication date: 18-06-2021
Publisher: Springer International Publishing
Keywords: Sleep Apnea
Polysomnography
Published in: Sleep and Breathing / Issue 2/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02413-0

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Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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