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Original Research: SLEEP MEDICINE |

Predictors for Treating Obstructive Sleep Apnea With an Open Nasal Cannula System (Transnasal Insufflation)

Georg Nilius, MD; Thomas Wessendorf, MD; Joachim Maurer, MD; Riccardo Stoohs, MD; Susheel P. Patil, MD, PhD; Norman Schubert, R-PSGT; Hartmut Schneider, MD, PhD
Author and Funding Information

From the HELIOS-Klinik Hagen-Ambrock Germany (Dr Nilius), University Witten-Herdecke; Ruhrlandklinik (Dr Wessendorf), Essen, Germany; HNO-Klinik der Universität (Dr Maurer), Mannheim, Germany; Somnolab (Dr Stoohs), Dortmund, Germany; and the Department of Pulmonary and Critical Care Medicine (Drs Patil and Schneider, Mr Schubert), Johns Hopkins University, Baltimore, MD.

Correspondence to: Georg Nilius, MD, Ambrocker Weg 60, 58091 Hagen, Germany; e-mail: georg.nilius@helios-kliniken.de


Funding/Support: This study was sponsored by Selion Inc. (HL 72126, P50 HL084945-01).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):521-528. doi:10.1378/chest.09-0357
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Background:  Obstructive sleep apnea (OSA) is a disorder that is associated with increased morbidity and mortality. Although continuous positive airway pressure effectively treats OSA, compliance is variable because of the encumbrance of wearing a sealed nasal mask throughout sleep. In a small group of patients, it was recently shown that an open nasal cannula (transnasal insufflation [TNI]) can treat OSA. The aim of this larger study was to find predictors for treatment responses with TNI.

Methods:  Standard sleep studies with and without TNI were performed in 56 patients with a wide spectrum of disease severity. A therapeutic response was defined as a reduction of the respiratory disturbance index (RDI) below 10 events/h associated with a 50% reduction of the event rate from baseline and was used to identify subgroups of patients particularly responsive or resistant to TNI treatment.

Results:  For the entire group (N = 56), TNI decreased the RDI from 22.6 ± 15.6 to 17.2 ± 13.2 events/h (P < .01). A therapeutic reduction in the RDI was observed in 27% of patients. Treatment responses were similar in patients with a low and a high RDI, but were greater in patients who predominantly had obstructive hypopneas or respiratory effort-related arousals and in patients who predominantly had rapid eye movement (REM) events. The presence of a high percentage of obstructive and central apneas appears to preclude efficacious treatment responses.

Conclusion:  TNI can be used to treat a subgroup of patients across a spectrum from mild-to-severe sleep apnea, particularly if their sleep-disordered breathing events predominantly consist of obstructive hypopneas or REM-related events but not obstructive and central apneas.

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