High flow nasal cannula for children with severe obstructive sleep apnea not compliant with continuous positive airway pressure

Abstract

Introduction: Continuous positive airway pressure (CPAP) is an effective treatment of severe obstructive sleep apnea (OSA) but poor compliance is a major limitation. High flow nasal cannula (HFNC) has been used as an alternative for these patients, but data about efficacy and long-term compliance are scarce. Material and methods: All consecutive patients, aged 0 to 18 years, treated with CPAP for a severe OSA defined as an apnea-hypopnea index (AHI) >10 events/hour, and not compliant with home CPAP therapy, defined by a CPAP use Results: Eight patients (2 boys, mean age 8.9±6.2 years, mean AHI 33±22 events/h) were included in the study: Down syndrome (n=6), Pierre Robin syndrome (n=1), Pfeiffer syndrome (n=1). After one month, 5 (62%) patients slept with HFNC more than 4 hours/night (mean compliance 7h10±0h36/night). HFNC corrected OSA in the 5 compliant patients (mean AHI 2±2 events/h with HFNC). HFNC was not accepted by the 3 oldest patients with Down syndrome. Conclusion: HFNC may be used as a rescue therapy for children not compliant with CPAP. Further studies are needed in order to identify which patients are more likely to adhere to this treatment.