Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. 179-188 (doi:10.1542/peds.2008-2824)

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ARTICLE

Effect of a High-Flow Open Nasal Cannula System on Obstructive Sleep Apnea in Children

Brian McGinley, MD^a, Ann Halbower, MD^b, Alan R. Schwartz, MD^c, Philip L. Smith, MD^c, Susheel P. Patil, MD, PhD^c, Hartmut Schneider, MD, PhD^c

^a Divisions of Pediatric Pulmonology
^c Pulmonary and Critical Care Medicine, Johns Hopkins Pediatric Sleep Disorders Center, Johns Hopkins University, Baltimore, Maryland
^b Children's Hospital Pediatric Sleep Disorders Center, Division of Pediatric Pulmonology, Children's Hospital and University of Colorado, Aurora, Colorado

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/m²), 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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Key Words: pediatric obstructive sleep apnea • treatment of sleep apnea • TNI

Abbreviations: OSA—obstructive sleep apnea • CPAP—continuous positive airway pressure • TNI—treatment with nasal insufflation • REM—rapid eye movement • NREM—nonrapid eye movement • AHI—apnea-hypopnea index

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