Relief of sleep-related oropharyngeal airway obstruction by continuous insufflation of the pharynx

Abstract

Sleep-related upper airway obstruction was treated by continuous insufflation of the pharynx (CIP) in 20 children. All had symptoms but only 1 qualified for a diagnosis of the obstructive sleep apnoea syndrome. Passage of warm humidified air through a thin nasopharyngeal tube at 2-10 litres/min (mean 3.5) relieved obstruction immediately in all patients. Relief was always clinically apparent and accompanied by reduced pleural pressure excursions during breathing. An index of the work of breathing (the product of breathing frequency and pleural pressure change per breath) fell by nearly 60% while patients were on CIP. Transcutaneous oxygen tension was monitored in 5 patients and was improved by CIP in each instance. Side-effects of CIP were minor and preventable with up to 72 days of continuous use. CIP is thus a simple and safe method that rapidly relieves severe oropharyngeal airway obstruction in children during sleep. Whether CIP is useful in domiciliary care or for adults has still to be established.