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. 2023 Nov;68(11):1527-1531.
doi: 10.4187/respcare.09890. Epub 2023 May 30.

Nocturnal High-Flow Nasal Cannula Therapy and Sinonasal Symptoms During Cystic Fibrosis Exacerbations

Michael D Davis  1 , Justin Brockbank  2 , Ryan Hayden  2 , Michael S Schechter  2 , Bruce K Rubin  2
Affiliations

Nocturnal High-Flow Nasal Cannula Therapy and Sinonasal Symptoms During Cystic Fibrosis Exacerbations

Michael D Davis et al. Respir Care. 2023 Nov.

Abstract

Background: Both nasal obstruction and sleep disturbance are common in patients with cystic fibrosis (CF). In patients with obstructive sleep apnea (OSA), studies suggest that these conditions are related and that nasal congestion improves with CPAP therapy. We hypothesized that subjects admitted to hospital for therapy of an exacerbation of CF would have both nasal symptoms and sleep disturbance and that these would improve with the initiation of nocturnal high-flow nasal cannula therapy (HFNC).

Methods: Twenty-five subjects with an exacerbation of CF were enrolled to randomly receive either 5 d of nocturnal HFNC at 20 L/min in the treatment group or 5 L/min of nocturnal nasal cannula air at ambient temperature and humidity in the low-flow group. On the first and last day of the study, the Sino-Nasal Outcome Test (SNOT-20) was administered to evaluate nasal symptoms, and sleep quality was measured using the Actiwatch 2.

Results: Fifteen subjects completed the study (6 HFNC, 9 low flow). We confirmed that subjects had significant sleep disturbance that did not improve over the 5 d of the study. Subjects also had disturbing nasal symptoms that significantly improved only in those receiving HFNC (pre 14 [20] vs post 6 [13], P = .027).

Conclusions: Similar to what has been reported in older subjects with OSA, nocturnal HFNC improves sinonasal symptoms in subjects with an exacerbation of CF. There was no measurable effect on sleep quality, which may be due to the short duration of the study, or to subjects being evaluated while being treated in a hospital setting.

Keywords: SNOT-20; high-flow nasal cannula; high-flow nasal therapy; nasal high-flow therapy; sleep.

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Conflict of interest statement

Dr Davis is funded by NIH/NHLBI PO1 HL128192 and the Indiana CTSI UL 1 TR002529. Dr Davis is a patent holder of Optate. Dr Davis discloses a relationship with Airbase Breathing Company. The remaining authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow chart. HFNC = high-flow nasal cannula.
Fig. 2.
Fig. 2.
Subjects receiving nocturnal nasal high-flow therapy had a significant improvement in sinonasal symptoms. There was no statistically significant difference in Sino-Nasal Outcome Test-20 (SNOT-20) score before and after treatment for the low-flow group (n = 9, pre 25 [16] vs post 22 [12], P = .37). There was a statistically significant decrease in SNOT-20 score in the high-flow nasal cannula group (n = 6, pre 14 [20] vs post 6 [12], P = .03). * P < .05. HFNC = high-flow nasal cannula.
Fig. 3.
Fig. 3.
Nocturnal nasal high-flow therapy did not adversely affect actigraphy results. Although sleep disturbance was common in subjects experiencing an exacerbation of cystic fibrosis and treated in the hospital, there was no significant effect of high-flow nasal cannula. Data points represent an average for the nights during which the actigraphy monitor was worn for each subject. HFNC = high-flow nasal cannula.
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