Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Pediatr Pulmonol. 2024 Oct;59(10):2635-2640. doi: 10.1002/ppul.27109. Epub 2024 Jun 5.
Obstructive sleep apnea (OSA) in infants is treated with low flow oxygen via nasal cannula (NC), CPAP (continous positive airway pressure), or surgery. Literature supports the use of high flow NC (HFNC) in children in the outpatient setting, however there is limited data on the use of HFNC in infants.
The purpose of this study was to compare HFNC and low-flow oxygen as treatments for OSA in infants.
A prospective pilot study was performed at two institutions. Infants with primarily OSA underwent a 3-4 h sleep study with HFNC titration at 6-14 lpm for OSA, followed by clinical polysomnography (PSG) for oxygen titration (1/8-1 lpm). Infants with primarily central apnea were excluded.
Nine infants were enrolled, with a mean age of 1.3 ± 1.7 months. Average apnea hypopnea index (AHI), average obstructive apnea hypopnea index (OAHI) and average central apnea index during the diagnostic PSG was 17.2 ± 7/h, 13.4 ± 5.4/h and 3.7 ± 4.8/h respectively. OSA improved in 44.4% of subjects with HFNC; the mean AHI and OAHI decreased from 15.6 ± 5.65/h and 12.8 ± 4.4/h on diagnostic PSG to 5.12 ± 2.5/h and 4.25 ± 2.5/h on titration PSG. OSA improved universally with low flow oxygen; the mean AHI decreased from 17.2 ± 7/h on diagnostic PSG to 4.44 ± 3.6/h on titration PSG.
HFNC reduced OSA in some infants, though low flow oxygen reduced OSA in all subjects. Respiratory instability (high loop gain) in infants may explain why infants responded to low flow oxygen. More studies are needed to determine if HFNC is beneficial in selected groups of infants with OSA.
婴儿阻塞性睡眠呼吸暂停（OSA）的治疗方法包括通过鼻导管（NC）给予低流量氧气、CPAP（持续气道正压通气）或手术。文献支持在门诊环境中使用高流量 NC（HFNC）治疗儿童，但关于 HFNC 在婴儿中的应用数据有限。
本研究旨在比较 HFNC 和低流量氧气作为治疗婴儿 OSA 的方法。
在两个机构进行了前瞻性试点研究。主要患有 OSA 的婴儿进行了 3-4 小时的睡眠研究，HFNC 滴定氧流量为 6-14 lpm 以治疗 OSA，随后进行临床多导睡眠图（PSG）以进行氧滴定（1/8-1 lpm）。主要患有中枢性呼吸暂停的婴儿被排除在外。
共有 9 名婴儿入组，平均年龄为 1.3±1.7 个月。诊断 PSG 期间的平均呼吸暂停低通气指数（AHI）、平均阻塞性呼吸暂停低通气指数（OAHI）和平均中枢性呼吸暂停指数分别为 17.2±7/h、13.4±5.4/h 和 3.7±4.8/h。HFNC 使 44.4%的患者的 OSA 得到改善；AHI 和 OAHI 的平均值从诊断 PSG 的 15.6±5.65/h 和 12.8±4.4/h 降低至滴定 PSG 的 5.12±2.5/h 和 4.25±2.5/h。低流量氧气普遍改善了 OSA；AHI 的平均值从诊断 PSG 的 17.2±7/h 降低至滴定 PSG 的 4.44±3.6/h。
HFNC 降低了一些婴儿的 OSA，但低流量氧气降低了所有患者的 OSA。婴儿的呼吸不稳定（高环路增益）可能解释了为什么婴儿对低流量氧气有反应。需要进一步研究以确定 HFNC 是否对患有 OSA 的特定婴儿群体有益。
