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

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 ef-ficacy 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 pol-ysomnography and recommended CPAP therapy were included in the study. Following diagnostic pol-ysomnography, 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 desatu-ration 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.(c) 2023 Elsevier B.V. All rights reserved.

Automated summary

The efficacy of heated high-flow nasal cannula (HFNC) therapy was compared with continuous positive airway pressure (CPAP) in treating moderate-to-severe obstructive sleep apnea (OSA) in children. The study found that HFNC and CPAP therapy had similar efficacy in reducing OSA severity in children with obesity and medical complexities.