Alessandro Amaddeo1, Sonia Khirani2, Annick Frapin3, Theo Teng3, Lucie Griffon4, Brigitte Fauroux4. 1. AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France. Electronic address: alessandro.amaddeo@aphp.fr. 2. AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France; ASV Santé, Gennevilliers, France. 3. AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France. 4. AP-HP, Hôpital Necker-Enfants Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France.
Abstract
OBJECTIVES: 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 but data about efficacy and objective long-term compliance are scarce; this study aims to address this lack of data. PATIENTS/ METHODS: All consecutive patients, aged 0-18 years, treated with CPAP for a severe OSA defined as an apnea-hypopnea index (AHI) > 10 events/h, and not compliant with home CPAP therapy, defined by a CPAP use of <2 h/night, after at least four weeks from CPAP initiation were considered eligible for the study. HFNC was started during an outpatient visit. Study outcomes were the objective compliance (number of hours use/night) after one month and the improvement of OSA on a respiratory polygraphy (RP) with HFNC. RESULTS: Eight patients (two 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, five (62%) patients slept with HFNC more than 4 h/night (mean compliance 7 h 10 min ± 0 h 36 min/night). HFNC corrected OSA in the five compliant patients (mean AHI 2 ± 2 events/h with HFNC). HFNC was not accepted by the three oldest patients with Down syndrome. CONCLUSION: A good compliance as well as a correction of OSA may be obtained with HFNC in selected children with OSA not compliant to CPAP. HFNC may be used as a rescue therapy for children not compliant with CPAP.
OBJECTIVES: 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 but data about efficacy and objective long-term compliance are scarce; this study aims to address this lack of data. PATIENTS/ METHODS: All consecutive patients, aged 0-18 years, treated with CPAP for a severe OSA defined as an apnea-hypopnea index (AHI) > 10 events/h, and not compliant with home CPAP therapy, defined by a CPAP use of <2 h/night, after at least four weeks from CPAP initiation were considered eligible for the study. HFNC was started during an outpatient visit. Study outcomes were the objective compliance (number of hours use/night) after one month and the improvement of OSA on a respiratory polygraphy (RP) with HFNC. RESULTS: Eight patients (two 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, five (62%) patients slept with HFNC more than 4 h/night (mean compliance 7 h 10 min ± 0 h 36 min/night). HFNC corrected OSA in the five compliant patients (mean AHI 2 ± 2 events/h with HFNC). HFNC was not accepted by the three oldest patients with Down syndrome. CONCLUSION: A good compliance as well as a correction of OSA may be obtained with HFNC in selected children with OSA not compliant to CPAP. HFNC may be used as a rescue therapy for children not compliant with CPAP.
Authors: Anna Christina Meyer; Jens Spiesshoefer; Nina Christina Siebers; Anna Heidbreder; Christian Thiedemann; Hartmut Schneider; Andrew T Braun; Winfried Randerath; Peter Young; Michael Dreher; Matthias Boentert Journal: Sleep Breath Date: 2020-12-02 Impact factor: 2.816