High-flow nasal cannula compared with continuous positive airway pressure in the treatment of obstructive sleep apnea

Purpose: Continuous positive airway pressure (CPAP) is a standard treatment for obstructive sleep apnea (OSA). However, CPAP has limitations. High-flow nasal cannula (HFNC) is already in use for various types of respiratory diseases. As HFNC generates positive airway pressure, it may be a potential candidate for OSA treatment. This prospective study compared the therapeutic effects of HFNC to CPAP in patients with OSA. Methods: Patients whose apnea–hypopnea index (AHI) was > 5 events/h were enrolled in this study. All participants were randomly divided into two groups. The first group underwent CPAP the first night and HFNC the second night. Conversely, the second group received HFNC the first night and CPAP the second night. Their respiratory events and sleep quality were compared using baseline polysomnography, CPAP, and HFNC. Results: In total, 28 participants completed this study. Median [interquartile range] AHI (35.0 [20.0–48.6] vs. 10.8 [5.5–20.6] events/h; p < 0.001) was significantly improved by the HFNC. However, sleep quality was not improved. When CPAP was compared directly with HFNC, CPAP demonstrated a more favorable effect for respiratory events (AHI 5.0 [2.0–7.0] vs. 10.8 [5.5–20.6] events/h; p < 0.001) and sleep efficiency (88.1 [79.9–92.5] vs. 77.9 [69.2–86.6] %; p = 0.001). Conclusion: The efficacy of CPAP was superior to HFNC for both respiratory events and sleep quality. Trial registration: ClinicalTrials.gov Identifier: NCT03843372; URL: www.clinicaltrials.gov;