Lei Guiyu, Yang Siliu, Wu Lili, Yin Yue, Xi Chunhua, Yang Qingwen, Wang Guyan
Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Anesthesiology, Beijing Dongcheng Maternal and Child Health Care Hospital, Beijing, People's Republic of China.
Risk Manag Healthc Policy. 2025 Jul 22;18:2469-2477. doi: 10.2147/RMHP.S518271. eCollection 2025.
Patients with obstructive sleep apnea (OSA) are at high risk for rapid oxygen desaturation during anesthesia induction. Apneic oxygenation with high-flow nasal oxygen (HFNO) has proven effective in prolonging safe apnea time in various patient populations. However, evidence for the efficacy of HFNO in OSA patients remains limited. This study aimed to evaluate whether the use of HFNO during anesthesia induction in OSA patients prolongs safe apnea time.
In this prospective randomized clinical trial, all participants underwent standardized pre-oxygenation and anesthesia induction. During the apneic period, oxygen was delivered either via HFNO at 60L/min (HFNO group) or with the nasal cannula left in place but disconnected from the oxygen source (control group, no supplemental oxygen). The primary outcome of this study was the time to peripheral oxygen desaturation (SpO < 95%) during apneic oxygenation. Secondary outcomes included minimum SpO re-oxygenation time, and tcCO levels.
The HFNO group demonstrated a significantly prolonged safe apnea time compared to the Control group (18.1 [12.1,18.8] vs 4.2 [2.5,6.3] minutes; <0.001). Additionally, minimum SpO levels were higher, and re-oxygenation time was shorter in the HFNO group ( <0.001 for both). Kaplan-Meier survival analysis revealed a substantially reduced risk of desaturation in the HFNO group (hazard ratio: 0.071; 95% CI, 0.021-0.222; <0.001). No serious adverse events were reported.
In this randomized controlled trial, HFNO significantly prolongs safe apnea time and enhances oxygenation during anesthesia induction in OSA patients. These findings highlight the potential of HFNO to improve perioperative airway management and patient safety in this high-risk population.
阻塞性睡眠呼吸暂停（OSA）患者在麻醉诱导期间存在快速氧饱和度下降的高风险。高流量鼻导管吸氧（HFNO）进行的无呼吸氧合已被证明在不同患者群体中可有效延长安全无呼吸时间。然而，HFNO对OSA患者疗效的证据仍然有限。本研究旨在评估在OSA患者麻醉诱导期间使用HFNO是否能延长安全无呼吸时间。
在这项前瞻性随机临床试验中，所有参与者均接受标准化的预给氧和麻醉诱导。在无呼吸期间，通过60L/min的HFNO输送氧气（HFNO组），或保留鼻导管但与氧气源断开连接（对照组，无补充氧气）。本研究的主要结局是无呼吸氧合期间外周氧饱和度下降（SpO<95%）的时间。次要结局包括最低SpO、再氧合时间和tcCO水平。
与对照组相比，HFNO组的安全无呼吸时间显著延长（18.1[12.1,18.8]分钟对4.2[2.5,6.3]分钟；P<0.001）。此外，HFNO组的最低SpO水平更高，再氧合时间更短（两者均P<0.001）。Kaplan-Meier生存分析显示，HFNO组的氧饱和度下降风险显著降低（风险比：0.071；95%CI，0.021-0.222；P<0.001）。未报告严重不良事件。
在这项随机对照试验中，HFNO显著延长了OSA患者麻醉诱导期间的安全无呼吸时间并增强了氧合。这些发现凸显了HFNO在改善这一高风险人群围手术期气道管理和患者安全方面的潜力。
