Postoperative use of high flow nasal insufflation for obstructive sleep apnea: a case series / 대한마취과학회지

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.

The Consequence of Cardiovascular Sympathetic Nervous System in Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The previous studies have shown that patients with obstructive sleep apnea (OSA) have shown high levels of cardiovascular diseases. These cardiovascular diseases are related to imbalance of cardiac autonomic systems. Alteration of QT interval in EKG reflects the increased cardiac sympathetic activity. The purpose of this study is to compare the cardiac sympathetic nerve activity between the control and OSA patients. SUBJECTS AND METHOD: All the patients were divided into the control group (n=20), whose RDI was less than 5 and the OSA group (n=40), whose RDI was more than 5. The OSA group was also divided into 3 groups, mild, moderate and severe, according to their RDI. The corrected QT interval (QTc) in EKG was checked at day time and during polysomnography. RESULTS: The number of hypertensive patients was significantly greater in the OSA group than the control group (p<0.001). The QTc interval was increased proportional to the RDI (p<0.001). There was a significant difference in the QTc intervals between the daytime period and apnea peak (p=0.031). CONCLUSION: Our results showed that the QT prolongation might be a prognostic factor in predicting the cardiac sympathetic hyperactivity in obstructive sleep apnea patients.