Nasal High Flow Therapy vs Oxygen Supplementation in OSA With CPAP Noncompliance

Nasal cannula
Nasal cannula
The average 4% oxygen desaturation index was statistically higher in the nasal high flow therapy group vs oxygen supplementation only control group.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — For patients with moderate to severe obstructive sleep apnea (OSA) who are not compliant with continuous positive airway pressure (CPAP) machine use, nasal high flow (NHF) therapy was not superior to supplemental oxygen alone postsurgery; however, both therapies showed equal efficacy in reducing the number of 4% oxygen desaturation index (4% ODI) events to <10/h on the first night postsurgery, according to research presented at the CHEST Annual Meeting, held October 6-10, 2018, in San Antonio, Texas.

To compare the effectiveness of NHF to low-flow oxygen supplementation for improving intermittent oxygen desaturations, researchers recruited preoperative patients with OSA who were also established as not CPAP compliant to this randomized, single-blinded, controlled trial. During the first night postsurgery, patients with apnea-hypopnea indices of >5 event/h were randomly assigned into an NHF at 30 liter per minute and oxygen at 1 liter per minute  group, or a 1 liter per minute oxygen supplement via nasal cannula control group.

Although only 42 of the 50 presurgery participants completed the study, they were all evaluated for the primary outcome of 4% ODI in the first night post-surgery. The average 4% ODI was statistically higher in the NHF group (7.4 median [IQR=3.5-13.3] events/h) than in the oxygen supplementation only control group (3.1 median [IQR=1.5-6.7] events/h; P =.024). Both methods were equally effective in reducing 4% ODI to <10 events/h (90.5% [n=19] of NHF patients vs 71.4% [n=15] of control group patients [P=.24]].

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The investigators concluded that “NHF at higher flow rates may be needed to reach increased upper airway patency and decreased dead space in these patients. Alternatively, NHF may have a role in milder forms of OSA. Further studies are needed to determine the role of NHF in the perioperative management of OSA patients.”

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Selim B, Gali B, Kashyap R, Morgenthaler T, Gay P. Nasal high flow therapy versus oxygen supplementation in postoperative care of obstructive sleep apnea patients with CPAP non-compliance: a pilot randomized study. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.