Skip to main content

Advertisement

SpringerLink
Log in

High flow nasal cannula therapy for obstructive sleep apnea in adults

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

Obstructive sleep apnea hypopnea syndrome (OSAHS) is characterized by the aggravation of upper airway constriction or obstruction, and it is associated with high incidence of various metabolic diseases and high mortality. Continuous positive airway pressure (CPAP) is now recommended as the first-line therapy for OSAHS, but its application is limited by its unsatisfactory patient tolerance. Previous studies have showed that high flow nasal cannula (HFNC) may improve symptoms in some patients with OSAHS. Therefore, the aim of the present study was to evaluate the effect of HFNC on OSAHS in a larger cohort than in previous research and to study the details of its therapeutic characteristics.

Methods

Polysomnography recording with and without HFNC was performed in 56 OSAHS patients with a wide spectrum of disease severity. Subgroups were divided by different treatment response criteria to identify the effect of this device.

Results

Of 56 patients enrolled, 9 were of mild severity (AHI, 5 to <15 events/h), 30 were of moderate severity (AHI, 15 to <30 events/h), and 17 patients were severe (AHI ≥ 30 events/h); 34 patients were younger than 50 years old and 22 patients were older than 50 years old. AHI decreased significantly (from 26.9 ± 14.7 to 21.5 ± 17.0 events/h, p < 0.001) after HFNC treatment in general. The subjects of responder group accounted for 21%. There was a negative correlation between the difference of AI and the difference of HI in nonresponder group before and after HFNC treatment, and the negative correlation was strong (Pearson’s test, r =  − 0.804, p = 0.000). Of the patients with mild to moderate severity, 76% achieved any AHI reduction and 24% of patients achieved at least 50% reduction in AHI. Older patients (the age of responder group 52.6 ± 11.7 vs. nonresponder group 43.7 ± 12.1 years old, p < 0.05), especially patients older than 50 years, had a better response rate (≤ 50 years 9% vs. > 50 years 41%, p = 0.007).

Conclusion

HFNC may be useful in treating patients with OSAHS, especially older patients and those with mild to moderate severity. HFNC may be an alternative treatment when patients are intolerant of CPAP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Drake CL, Day R, Hudgel D et al (2003) Sleep during titration predicts continuous positive airway pressure compliance. Sleep 26:308–311. https://doi.org/10.1093/sleep/26.3.308

    Article  PubMed  Google Scholar 

  2. Smith PL, Wise RA, Gold AR et al (1985) Upper airway pressure-flow relationships in obstructive sleep apnea. J Appl Physiol 1988(64):789–795. https://doi.org/10.1152/jappl.1988.64.2.789

    Article  Google Scholar 

  3. Mansour KF, Rowley JA, Meshenish AA et al (1985) A mathematical model to detect inspiratory flow limitation during sleep. J Appl Physiol 2002(93):1084–1092. https://doi.org/10.1152/japplphysiol.01140.2001

    Article  Google Scholar 

  4. Arzt M, Young T, Finn L et al (2005) Association of sleep-disordered breathing and the occurrence of stroke. Am J Respir Crit Care Med 172:1447–1451. https://doi.org/10.1164/rccm.200505-702OC

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gleadhill IC, Schwartz AR, Schubert N et al (1991) Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis 143:1300–1303. https://doi.org/10.1164/ajrccm/143.6.1300

    Article  CAS  PubMed  Google Scholar 

  6. Weaver TE, Maislin G, Dinges DF et al (2003) Self-efficacy in sleep apnea: instrument development and patient perceptions of obstructive sleep apnea risk, treatment benefit, and volition to use continuous positive airway pressure. Sleep 26:727–732. https://doi.org/10.1093/sleep/26.6.727

    Article  PubMed  Google Scholar 

  7. McGinley BM, Patil SP, Kirkness JP et al (2007) A nasal cannula can be used to treat obstructive sleep apnea. Am J Respir Crit Care Med 176:194–200. https://doi.org/10.1164/rccm.200609-1336OC

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aloia MS, Stanchina M, Arnedt JT et al (2005) Treatment adherence and outcomes in flexible vs standard continuous positive airway pressure therapy. Chest 127:2085–2093. https://doi.org/10.1378/chest.127.6.2085

    Article  PubMed  Google Scholar 

  9. Olson EJ, Moore WR, Morgenthaler TI et al (2003) Obstructive sleep apnea-hypopnea syndrome. Mayo Clin Proc 78:1545–1552. https://doi.org/10.4065/78.12.1545

    Article  PubMed  Google Scholar 

  10. Schwartz AR, Smith PL, Wise RA et al (1985) Effect of positive nasal pressure on upper airway pressure-flow relationships. J Appl Physiol 1989(66):1626–1634. https://doi.org/10.1152/jappl.1989.66.4.1626

    Article  Google Scholar 

  11. de Klerk A (2008) Humidified high-flow nasal cannula: is it the new and improved CPAP? Adv Neonatal Care 8:98–106. https://doi.org/10.1097/01.ANC.0000317258.53330.18

    Article  PubMed  Google Scholar 

  12. Eastwood PR, Szollosi I, Platt PR et al (2002) Comparison of upper airway collapse during general anaesthesia and sleep. Lancet 359:1207–1209. https://doi.org/10.1016/S0140-6736(02)08224-7

    Article  PubMed  Google Scholar 

  13. Nilius G, Wessendorf T, Maurer J et al (2010) Predictors for treating obstructive sleep apnea with an open nasal cannula system (transnasal insufflation). Chest 137:521–528. https://doi.org/10.1378/chest.09-0357

    Article  PubMed  Google Scholar 

  14. Sowho MO, Woods MJ, Biselli P et al (2015) Nasal insufflation treatment adherence in obstructive sleep apnea. Sleep Breath 19:351–357. https://doi.org/10.1007/s11325-014-1027-4

    Article  PubMed  Google Scholar 

  15. (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22: 667–689

  16. Aloia MS, Ilniczky N, Di Dio P et al (2003) Neuropsychological changes and treatment compliance in older adults with sleep apnea. J Psychosom Res 54:71–76. https://doi.org/10.1016/s0022-3999(02)00548-2

    Article  PubMed  Google Scholar 

  17. Eckert DJ, Malhotra A, Lo YL et al (2009) The influence of obstructive sleep apnea and gender on genioglossus activity during rapid eye movement sleep. Chest 135:957–964. https://doi.org/10.1378/chest.08-2292

    Article  PubMed  Google Scholar 

  18. Marin JM, Carrizo SJ, Vicente E et al (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053. https://doi.org/10.1016/S0140-6736(05)71141-7

    Article  PubMed  Google Scholar 

  19. Spoletini G, Alotaibi M, Blasi F et al (2015) Heated Humidified High-Flow Nasal Oxygen in Adults: Mechanisms of Action and Clinical Implications. Chest 148:253–261. https://doi.org/10.1378/chest.14-2871

    Article  PubMed  Google Scholar 

  20. Findley LJ, Wilhoit SC, Suratt PM (1985) Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest 87:432–436. https://doi.org/10.1378/chest.87.4.432

    Article  CAS  PubMed  Google Scholar 

  21. Oliven A, Carmi N, Coleman R et al (2001) Age-related changes in upper airway muscles morphological and oxidative properties. Exp Gerontol 36:1673–1686. https://doi.org/10.1016/s0531-5565(01)00127-9

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China

    Hu Yan, Li Qinghua, Pi Mengyuan, Zhao Long, Dong Xiaosong & Han Fang

  2. PKU-UPenn Sleep Center, Peking University International Hospital, Beijing, People’s Republic of China

    Li Mengjie

  3. Department of Pulmonary Diseases and Oncology, Pu’er Hospital of Traditional Chinese Medicine, Pu’er, Yunnan Province, People’s Republic of China

    Chen Yaoyu

Authors
  1. Hu Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Qinghua
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pi Mengyuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chen Yaoyu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhao Long
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Li Mengjie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dong Xiaosong
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Han Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HY collected the clinical data and images and analyzed and interpreted the data, and HY wrote the manuscript in consultation with LQ, PM, CY, LM, ZL, DX, and HF. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Han Fang.

Ethics declarations

Ethics approval and consent to participate

The ethic committee of our institution waived the ethical review.

Consent for publication

All authors have read and consented on the publication of this manuscript.

Conflict of interest

All authors report no conflicts of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yan, H., Qinghua, L., Mengyuan, P. et al. High flow nasal cannula therapy for obstructive sleep apnea in adults. Sleep Breath 26, 783–791 (2022). https://doi.org/10.1007/s11325-021-02453-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02453-6

Keywords

Search

Navigation