Excerpt from the article located at http://www.medscape.com/viewarticle/559811

Nasal Cannula May Help Treat Obstructive Sleep Apnea

July 16, 2007 — A nasal cannula for insufflating high airflows can be used to treat a diverse group of patients with obstructive sleep apnea, according to the results of a study reported in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.

"Obstructive sleep apnea syndrome is due to upper airway obstruction and is associated with increased morbidity," write Brian M. McGinley, MD, from the Johns Hopkins Sleep Disorders Center in Baltimore, Maryland, and colleagues. "Although continuous positive airway pressure efficaciously treats obstructive apneas and hypopneas, treatment is impeded by low adherence rates."

In this study, 11 subjects with obstructive apnea–hypopnea syndrome ranging from mild to severe (5-60 events/h) were administered warm and humidified air at 20 L/minute through a minimally intrusive, open nasal cannula. Mean age was 49.7 ± 5.0 years, and mean body mass index was 30.5 ± 4.3 kg/m2.

Measurements were based on standard sleep-disordered breathing and arousal indices, and a subset of patients underwent evaluation of pharyngeal pressure and ventilation to determine the mechanism of action of treatment with nasal insufflation.

Nasal insufflation was associated with a decrease in the mean apnea–hypopnea index from 28 ± 5 to 10 ± 3 events per hour (P < .01) and with a decrease in the respiratory arousal index from 18 ± 2 to 8 ± 2 events per hour (P < .01). The apnea–hypopnea index decreased to fewer than 10 events per hour in 8 of 11 subjects and to fewer than 5 events per hour in 4 subjects.

"The mechanism of action appears to be through an increase in end-expiratory pharyngeal pressure, which alleviated upper airway obstruction and improved ventilation," the authors write. "Our findings demonstrate clinical proof of concept that a nasal cannula for insufflating high airflows can be used to treat a diverse group of patients with obstructive sleep apnea."

Study limitations include use of flow rates of only 10 and 20 L/minute, possible dislodgement of the cannula during the night in at least 1 patient, occurrence of apneas possibly being dependent on body position, TNI used for only 1 night, and potentially poor agreement between scorers of arousal indices.

"Because one flow rate and cannula size was sufficient to stabilize breathing patterns in the

majority of our subjects, titration may be obviated, thereby streamlining the initiation of treatment," the authors conclude. "Moreover, the minimally intrusive nasal interface of TNI may improve patient adherence, and may ultimately prove more effective in managing the long-term morbidity and mortality of sleep apnea. Further studies will be required to extend these findings and to determine the ultimate role of TNI in managing obstructive sleep apnea."

Seleon GmbH, Germany, supported this study and has financial arrangements with some of its authors.

Am J Respir Crit Care Med. 2007;176:194–200.


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Erin
Mom to 3 children 4 and under!! including a sweet 2 year old who has chronic kidney failure with severe cystic encephalomalacia, cortically blind, mixed cerebral palsy, severe global delays, Sleep Apnea, possible RLS, reflux, G tube

Forgot to mention that the brochure for the equipment says studies have included trials with children. It's only available in Europe and not yet FDA approved because larger clinical trials still need to be conducted.


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Erin
Mom to 3 children 4 and under!! including a sweet 2 year old who has chronic kidney failure with severe cystic encephalomalacia, cortically blind, mixed cerebral palsy, severe global delays, Sleep Apnea, possible RLS, reflux, G tube

Very interesting. I hope they may be able to perfect this with time. It seems like the need to get the apnea levels at a better rate from under 10 an hour. Hopefully this is the beginning of something great!


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Heather-Mom to Hannah(8-hose head) and Logan(4), wife to Paul (also a hose head)

I'm not 100% sure, but it seems the way it works is that in breathing out against the flow of air coming in, it forces the throat open wider, so it is less likely to close up on the next inhale. Guess there's no EPR then.

John


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"Death doesn't really worry me that much, I'm not frightened about it... I just don't want to be there when it happens." - Woody Allen
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