NASAL HIGH FLOW THERAPY VERSUS OXYGEN SUPPLEMENTATION IN POSTOPERATIVE CARE OF OBSTRUCTIVE SLEEP APNEA PATIENTS WITH CPAP NON-COMPLIANCE: A PILOT RANDOMIZED STUDY

Abstract

SESSION TITLE: Comorbid Diseases and Sleep Apnea SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2018 07:30 AM - 08:30 AM PURPOSE: Increased postoperative oxygen desaturations in obstructive sleep apnea (OSA) patients have being associated with increased ICU admissions and adverse cardiopulmonary events. Nasal High Flow (NHF) therapy in OSA improves oxygen stores by increasing upper airway patency and lung volumes and by decreasing dead space. Our objective was to compare the efficacy of Nasal High Flow Therapy (NHF) with low-flow oxygen supplementation in improving postoperative intermittent desaturations of OSA patients with CPAP non-compliance. METHODS: We conducted a single blinded randomized controlled trial, in which OSA patients with CPAP non-compliant were recruited from the pre-operative evaluation (POE) clinic. Patients were confirmed to have OSA by polysomnographic study, and declined to use of CPAP for upcoming elective surgery. Participants with an apnea–hypopnea index of ≥ 5 events per hour were randomly assigned to receive NHF at 30 LPM plus oxygen at 1 LPM or oxygen supplement at 1 LPM via nasal cannula (control) during the first post-surgical night. Baseline demographic, cardiovascular risks and post-operative recovery room’s vital signs were collected. The primary outcome was the 4% oxygen desaturation index (ODI 4%) in the first postoperative night. The analysis was done by using JMP 12.2 (SAS, NC) RESULTS: Of 50 OSA patients who underwent randomization, 42 (84%) completed the study, All of them were evaluated for the ODI 4% in the first postoperative night. On average, the ODI 4% was statistically higher in the group receiving NHF [7.4 median (IQR=3.5-13.3) events per hour] than in the group receiving oxygen supplementation alone [3.1 median (IQR=1.5-6.7) events per hour]; p=0.024. NHF was equally effective to supplemental oxygen alone to reduce ODI 4% < 10 events/h [19 patients (90.5%) in NHF vs. 15 patients (71.4%) in control group; p = 0.24) CONCLUSIONS: In moderate-severe OSA patients with CPAP non-compliance, NHF therapy did not offer any advantage over supplemental oxygen alone, but both therapies were equally effective in reducing the 4%ODI to < 10 events/h during the first postoperative night. CLINICAL IMPLICATIONS: Nasal High Flow Therapy (NHF) at low flow (30 LPM) did not offer any advantage over supplemental oxygen alone to treat postoperative oxygen desaturations in moderate-severe OSA patients with CPAP non-compliance. NHF at higher flow rates may be needed to reach increased upper airway patency and decreased dead space in these patients. Alternatively, NHF may have a role in milder forms of OSA. Further studies are needed to determine the role of NHF in the perioperative management of OSA patients. DISCLOSURES: No relevant relationships by Bhargavi Gali, source=Web Response No relevant relationships by Peter Gay, source=Web Response No relevant relationships by Rahul Kashyap, source=Web Response No relevant relationships by Timothy Morgenthaler, source=Web Response No relevant relationships by Bernardo Selim, source=Web Response