The effectiveness of high-flow nasal cannula therapy in comparison with continuous positive airway pressure therapy in patients with obstructive sleep apnea: an open-label randomized crossover trial.

Abstract

Study objectives: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). However, its effectiveness is limited by poor long-term adherence. A few recent studies have investigated the effectiveness of high-flow nasal cannula (HFNC) in treating OSA; however, its role remains uncertain. This study aimed to determine the effectiveness of HFNC, compared with CPAP, in the treatment of patients with OSA.

Methods: This prospective, open-label, randomized crossover trial was conducted on treatment-naïve, newly diagnosed patients with OSA. Participants underwent CPAP and HFNC titration studies in 1 of 2 crossover sequences. The American Academy of Sleep Medicine guidelines for CPAP titration were followed for titration of both CPAP and HFNC. The initial flow rate of HFNC was set at 10 L/min, and the flow rate was increased by 10 L/min, up to a maximum of 60 L/min, to eliminate all respiratory events.

Results: Sixty-eight participants completed the study. Compared with the diagnostic polysomnography, the apnea-hypopnea index decreased by a median of 52% with HFNC therapy (18-77%, P value < .001). Clinically acceptable titration was observed in 48% of patients receiving HFNC therapy, whereas 53% experienced a ≥ 50% reduction in the apnea-hypopnea index. The efficacy of HFNC decreased as OSA severity increased. However, CPAP therapy provided superior control of OSA, with a lower apnea-hypopnea index (5.8 vs 16.6 events/h, P values < .001). Sleep architecture significantly improved with CPAP but declined with HFNC.

Conclusions: HFNC serves as a viable option for patients intolerant to CPAP, although careful patient selection is essential.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Effect of High Flow Nasal Cannula Versus Continues Positive Airway Pressure in Adults With Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/study/NCT05475119; Identifier: NCT05475119.

Citation: Wali S, Batawi G, Bin Afeef G, et al. The effectiveness of high-flow nasal cannula therapy in comparison with continuous positive airway pressure therapy in patients with obstructive sleep apnea: an open-label randomized crossover trial. J Clin Sleep Med. 2025;21(6):1023-1031.