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

Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). However, its effectiveness is limited by poor long-term compliance. 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. This prospective open-label randomized crossover trial was conducted on treatment-naïve, newly-diagnosed patients with OSA. Participants underwent a CPAP and a HFNC titration studies in one-of-two 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. Sixty-eight participants completed the study. Compared to the diagnostic PSG, the apnea-hypopnea index (AHI) decreased by a median of 52% with HFNC therapy [18-77, p value < 0.001]. Clinically acceptable titration was observed in 48% of patients receiving HFNC therapy, whereas 53% experienced a ≥50% reduction in the AHI. The efficacy of HFNC decreased as OSA severity increased. However, CPAP therapy provided superior control of OSA, with a lower AHI (5.8 vs. 16.6, p values < 0.001). Sleep architecture significantly improved with CPAP; however, declined with HFNC. HFNC serves as a viable option for patients intolerant to CPAP, although careful patient selection is essential.