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. 2009 Jul;124(1):179-88.
doi: 10.1542/peds.2008-2824.

Effect of a high-flow open nasal cannula system on obstructive sleep apnea in children

Brian McGinley  1 , Ann Halbower, Alan R Schwartz, Philip L Smith, Susheel P Patil, Hartmut Schneider
Affiliations

Effect of a high-flow open nasal cannula system on obstructive sleep apnea in children

Brian McGinley et al. Pediatrics. 2009 Jul.

Abstract

Objective: Obstructive sleep apnea syndrome in children is associated with significant morbidity. Continuous positive airway pressure (CPAP) treats obstructive apnea in children, but is impeded by low adherence. We, therefore, sought to assess the effect of warm humidified air delivered through an open nasal cannula (treatment with nasal insufflation [TNI]) on obstructive sleep apnea in children with and without adenotonsillectomy.

Methods: Twelve participants (age: 10 +/- 1 years; BMI: 35 +/- 14 kg/m(2)), with obstructive apnea-hypopnea syndrome ranging from mild to severe (2-36 events per hour) were administered 20 L/min of air through a nasal cannula. Standard sleep architecture, sleep-disordered breathing, and arousal indexes were assessed at baseline, on TNI, and on CPAP. Additional measures of the percentage of time with inspiratory flow limitation, respiratory rate, and inspiratory duty cycle were assessed at baseline and on TNI.

Results: TNI reduced the amount of inspiratory flow limitation, which led to a decrease in respiratory rate and inspiratory duty cycle. TNI improved oxygen stores and decreased arousals, which decreased the occurrence of obstructive apnea from 11 +/- 3 to 5 +/- 2 events per hour (P < .01). In the majority of children, the reduction in the apnea-hypopnea index on TNI was comparable to that on CPAP.

Conclusions: TNI offers an alternative to therapy to CPAP in children with mild-to-severe sleep apnea. Additional studies will be needed to determine the efficacy of this novel form of therapy.

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Figures

FIGURE 1
FIGURE 1
Qualitative airflow signals from a nasal mask attached to a pneumotachograph compared with those acquired concurrently from a nasal cannula attached to a pressure transducer during TNI trials are depicted. Changes in baseline airflow in the nasal cannula at the onset and offset of TNI are attributed to an alternating current-coupled signal with a long time constant.
FIGURE 2
FIGURE 2
One study participant wearing the TNI cannula (left) and the TNI device is depicted (right). Cannula length is 1800.0 mm, outer diameter 5.0-mm cannula and nasal prongs, and inner diameter 3.4 mm. The weight of the TNI device including the compressor is ~10 kg.
FIGURE 3
FIGURE 3
Two hypoponeas during REM sleep at baseline are shown (top left), which are abolished on TNI (top right). During NREM sleep, the same child exhibited inspiratory flow limitation characterized by plateauing of the inspiratory contour (bottom left), which was alleviated with TNI (bottom right). EOG indicates electrooculogram; EEG, electroencephalogram; SpO2, oxyhemoglobin saturation. RR indicates respiratory rate.
FIGURE 4
FIGURE 4
The AHIs are displayed for the baseline compared with the TNI-treatment night during NREM (left), REM (middle), and for the entire night (right). Data presented are means ± SEMs. a Participants with residual sleep apnea on TNI. bParticipants with suboptimal AHI responses on TNI compared with CPAP. ◦Children without adenotonsillectomy.
FIGURE 5
FIGURE 5
Graphic representations of the respiratory pattern during NREM sleep for the baseline compared with TNI: percentage of NREM sleep time with inspiratory flow limitation (left); inspiratory duty cycle, which is the inspiratory time/duration of the respiratory cycle (middle); and respiratory rate (right). Data presented are means ± SEMs.
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