Sleep apnea-specific hypoxic burden and pulse rate response in children using high flow nasal cannula therapy compared with continuous positive airway pressure

Chun Ting Au; Nobel Tsz Kin Yuen; Colin Massicotte; Kate Ching Ching Chan; Albert Martin Li; Indra Narang

doi:10.1016/j.sleep.2024.09.032

Sleep apnea-specific hypoxic burden and pulse rate response in children using high flow nasal cannula therapy compared with continuous positive airway pressure

Sleep Med. 2024 Sep 19:124:187-190. doi: 10.1016/j.sleep.2024.09.032. Online ahead of print.

Authors

Chun Ting Au¹, Nobel Tsz Kin Yuen², Colin Massicotte³, Kate Ching Ching Chan⁴, Albert Martin Li⁴, Indra Narang⁵

Affiliations

¹ Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
³ Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
⁵ Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address: indra.narang@sickkids.ca.

PMID: 39316929
DOI: 10.1016/j.sleep.2024.09.032

Abstract

Background: Elevated sleep apnea-specific hypoxic burden (HB) and pulse rate response (ΔHR) are associated with a higher cardiovascular risk in adults. The clinical significance of HB and ΔHR in children with obstructive sleep apnea (OSA) and their responses to therapy have not yet been investigated. This study aimed to compare the efficacy of high flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) in reducing HB and ΔHR in children.

Methods: This analysis included 17 children (11 males, mean age: 12.6 ± 3.9 years) with obesity and/or medical complexity and moderate-to-severe OSA. Each participant underwent two additional sleep studies: one for HFNC titration and another for CPAP titration. HB and ΔHR were derived from the oximetry and pulse rate signals from overnight sleep studies, respectively.

Results: Both HFNC and CPAP demonstrated significant reductions in HB from baseline, with similar magnitudes [HFNC: -129 (standard error, SE 55) %min/h, p = 0.003; CPAP: -138 (SE 53) %min/h, p = 0.005]. However, for ΔHR, a significant reduction from baseline was observed only in the CPAP group [-2.7 (SE 1.1) beats/min, p = 0.049], not the HFNC group [-1.0 (SE 1.4) beats/min, p = 0.67].

Conclusions: HFNC is as effective as CPAP in treating hypoxia in children with OSA, but HFNC might be less effective than CPAP in mitigating cardiovascular stress from autonomic disturbances during obstructive events.