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

Autor: Fishman H; The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada., Al-Shamli N; Division of Respiratory Medicine, Department of Pediatrics, Sultan Qaboos University, Muscat 123, Oman., Sunkonkit K; Division of Pulmonary and Critical Care, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand., Maguire B; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada., Selvadurai S; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada., Baker A; The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada., Amin R; The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; The University of Toronto, Toronto, Ontario, Canada., Propst EJ; Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Kids, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada., Wolter NE; Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Kids, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada., Eckert DJ; Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia., Cohen E; Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada., Narang I; The Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, 4539 Hill Wing, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada; Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Canada; The University of Toronto, Toronto, Ontario, Canada. Electronic address: indra.narang@sickkids.ca.
Jazyk: angličtina
Zdroj: Sleep medicine [Sleep Med] 2023 Jul; Vol. 107, pp. 81-88. Date of Electronic Publication: 2023 Apr 21.
DOI: 10.1016/j.sleep.2023.04.017
Abstrakt: Objective/background: Moderate-to-severe obstructive sleep apnea (OSA) is highly prevalent in children with obesity and/or underlying medical complexity. The first line of therapy, adenotonsillectomy (AT), does not cure OSA in more than 50% of these children. Consequently, continuous positive airway pressure (CPAP) is the main therapeutic option but adherence is often poor. A potential alternative which may be associated with greater adherence is heated high-flow nasal cannula (HFNC) therapy; however, its efficacy in children with OSA has not been systematically investigated. The study aimed to compare the efficacy of HFNC with CPAP to treat moderate-to-severe OSA with the primary outcome measuring the change from baseline in the mean obstructive apnea/hypopnea index (OAHI).
Participants/methods: This was a single-blinded randomized, two period crossover trial conducted from March 2019 to December 2021 at a Canadian pediatric quaternary care hospital. Children aged 2-18 years with obesity and medical complexity diagnosed with moderate-to-severe OSA via overnight polysomnography and recommended CPAP therapy were included in the study. Following diagnostic polysomnography, each participant completed two further sleep studies; a HFNC titration study and a CPAP titration study (9 received HFNC first, and 9 received CPAP first) in a random 1:1 allocation order.
Results: Eighteen participants with a mean ± SD age of 11.9 ± 3.8 years and OAHI 23.1 ± 21.7 events/hour completed the study. The mean [95% CI] reductions in OAHI (-19.8[-29.2, -10.5] vs. -18.8 [-28.2, -9.4] events/hour, p = 0.9), nadir oxygen saturation (7.1[2.2, 11.9] vs. 8.4[3.5, 13.2], p = 0.8), oxygen desaturation index (-11.6[-21.0, -2.3] vs. -16.0[-25.3, -6.6], p = 0.5) and sleep efficiency (3.5[-4.8, 11.8] vs. 9.2[0.9, 15.5], p = 0.2) with HFNC and CPAP therapy were comparable between conditions.
Conclusion: HFNC and CPAP therapy yield similar reductions in polysomnography quantified measures of OSA severity among children with obesity and medical complexities.
Trial Registration: NCT05354401 ClinicalTrials.gov.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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