Postoperative use of high flow nasal insufflation for obstructive sleep apnea

• Main Authors: Avinash Gobindram, Prit Anand Singh, Kelvin Howyow Quek
• Format: Article
• Language: English
• Published: Korean Society of Anesthesiologists 2019-12-01
• Series: Korean Journal of Anesthesiology
• Subjects: continuous positive airway pressure; high flow nasal oxygen; hypopnea; obstructive sleep apnea; optiflow; respiratory distress index; stop-bang score
• Online Access: http://ekja.org/upload/pdf/kja-d-18-00368.pdf

Background Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for obstructive sleep apnea (OSA), although, associated with poor patient compliance. Conversely, high flow, humidified, temperature-regulated nasal insufflation of oxygen or air is well tolerated. Case We describe our experience of three patients with known or suspected moderate to severe OSA who were poorly compliant to CPAP therapy and received high flow nasal insufflation (HFNI) postoperatively. None had significant episodes of desaturation (SpO2 < 95%) and all patients uniformly reported superior comfort levels than with the CPAP therapy. HFNI generates small amounts of positive end-expiratory pharyngeal pressure, increases inspiratory airflow and decreases dead space ventilation. Due to the open system, less difficulty with the patient-mask interface and improved patient comfort is experienced. These factors help prevent hypopnea and lead to enhanced sleep continuity. Conclusions HFNI may be a promising alternative to CPAP therapy in the perioperative setting.