Efficacy of high flow nasal cannula as an alternative to continuous positive airway pressure therapy in surgical patients with suspected moderate to severe obstructive sleep apnea

Abstract

Purpose: To compare the efficacy of High flow nasal cannula (HFNC) as an alternative to Continuous Positive Airway Pressure (CPAP) therapy on the first postoperative night in patients with suspected moderate to severe obstructive sleep apnea (OSA).

Methods: This is randomised controlled trial conducted in a tertiary hospital which included elective surgical patients with STOP-BANG score of 5 and above. Forty patients were randomised into one of the four postoperative treatment groups: CPAP, or HFNC at three different flow rates (20 L/min, 30 L/min and 40 L/min). The primary outcome measured was the number of recorded drops in baseline SpO2 of >4%. Secondary outcomes measured included the need for supplemental oxygen or other interventions and the total number of hours of usage of the device. Patient satisfaction, preference for device and reasons for their preference were also collected.

Results: CPAP was used for a significantly fewer number of hours compared to HFNC (at all flow rates) during the first postoperative night. There was no significant difference in the primary outcome or in the requirement for other interventions between the four treatment groups. 73.3% of patients in the HFNC group preferred the use of HFNC to the use of CPAP. Reasons for user preference for HFNC include device comfort, ease of use, reduced noise levels and perception of efficacy.

Conclusions: HFNC could be an useful alternative to CPAP as it is not inferior to CPAP in the perioperative management of OSA and is better tolerated.

Keywords: CPAP; HFNC; OSA; Surgical patients.