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. 2025 Sep:133:106637.
doi: 10.1016/j.sleep.2025.106637. Epub 2025 Jun 14.

Efficacy of high-flow nasal cannula therapy and its effectiveness in home settings for paediatric obstructive sleep apnoea

Kate C Chan  1 , Chun T Au  2 , Ka L Kwok  3 , Ming Yang  4 , Nobel Tk Yuen  4 , Michelle Wl Yu  4 , Albert M Li  5
Affiliations
Free article

Efficacy of high-flow nasal cannula therapy and its effectiveness in home settings for paediatric obstructive sleep apnoea

Kate C Chan et al. Sleep Med. 2025 Sep.
Free article

Abstract

Background and objectives: Adherence to continuous positive airway pressure (CPAP) remains a major issue for children and adolescents with obstructive sleep apnoea (OSA). Hence, there is a demand for alternative treatment options. This study aimed to investigate the efficacy of high-flow nasal cannula (HFNC) therapy in children with moderate-to-severe OSA (MS-OSA) and to investigate adherence, quality of life and behavioural measures with HFNC compared to CPAP.

Methods: Children and adolescents with MS-OSA underwent titration studies with HFNC and CPAP on two consecutive nights. The efficacy of HFNC in treating MS-OSA, determined by the residual obstructive apnoea-hypopnoea index (OAHI) with the device, was compared to CPAP. Eligible participants underwent a 6-month interventional trial with HFNC and CPAP to compare self-reported adherence, quality of life, and behavioural measures.

Results: Twenty-nine participants (90 % male) with a mean ± SD age of 12.8 ± 3.0 years completed the titration studies. The mean residual OAHI with HFNC and CPAP was 5.4 ± SD 12.6 and 3.59 ± SD 7.8 events/h respectively (p = 0.281). The mean [95 % confidence interval] reductions in OAHI with HFNC and CPAP were -7.2 [-9.2, -5.1] vs. -9.0 [-12.2, -5.9] respectively. Twenty-two participants underwent the intervention study. Overall, adherence to CPAP was significantly better than that to HFNC therapy. Significant improvement in OSA-18 scores was observed with both HFNC and CPAP, but not in daytime sleepiness and behavioural measures.

Conclusions: HFNC is an alternative treatment option with comparable efficacy to CPAP in alleviating disease severity in paediatric patients with MS-OSA. However, self-reported adherence and behavioural outcomes were not improved with HFNC therapy compared to CPAP.

Keywords: Adherence; Children; High-flow nasal cannula therapy; Obstructive sleep apnoea; Quality of life; Treatment; Treatment outcomes.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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