BACKGROUND The low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. The authors considered whether the combination of high-flow nasal cannula and upper-body elevation could improve postoperative OSA. METHODS This nonblinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 l · min-1 with 40% oxygen concentration) with and without upper-body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants. RESULTS Twenty-two of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean ± SD, 60 ± 12 events · h-1; n = 19) was reduced by 15 (95% CI, 6 to 30) events · h-1 with head-of-bed elevation alone (P = 0.002), 10.9 (95% CI, 1 to 21) events · h-1 with high-flow nasal cannula alone (P = 0.028), and 23 (95% CI, 13 to 32) events · h-1 with combined head-of-bed elevation and high-flow nasal cannula (P < 0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 12 events · h-1 (95% CI, 2 to 21; P = 0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation, also improved overnight oxygenation. No harmful events were observed. CONCLUSIONS The combination of high-flow nasal cannula and upper-body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy. EDITOR’S PERSPECTIVE

中文翻译：

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高流量鼻导管联合上半身抬高治疗术后睡眠呼吸障碍：随机交叉试验。

背景 未经治疗的阻塞性睡眠呼吸暂停 (OSA) 术后患者持续气道正压治疗的接受率较低，这表明有必要开发一种替代的术后气道管理策略。作者考虑了高流量鼻导管和上身抬高的组合是否可以改善术后 OSA。方法 这项在一家大学医院进行的非盲随机交叉研究调查了对改良呼吸暂停低通气指数的影响，该研究仅基于气流信号，没有动脉氧饱和度标准（基于流量的呼吸暂停低通气指数，主要结果），高流量鼻中度至重度 OSA 患者的套管（20 l·min-1，氧气浓度为 40%）伴或不伴上身抬高。术前睡眠研究在家里（对照，无床头抬高）和医院（床头抬高 30 度）进行。在术后第一个和第二个晚上，在有或没有 30 度床头抬高的情况下应用高流量鼻导管，随机分配给 23 名符合条件的参与者。结果 23 人中有 22 人 (96%) 接受了高流量鼻插管。四名参与者退出了研究。基于控制流的呼吸暂停低通气指数（平均值 ± SD，60 ± 12 个事件·h-1；n = 19）减少了 15 个（95% CI，6 至 30）个事件·h-1，床头抬高单独使用 (P = 0.002)，10.9 (95% CI，1 至 21) 事件 · h-1 单独使用高流量鼻导管 (P = 0.028)，和 23 (95% CI，13 至 32) 事件 · h- 1 联合床头抬高和高流量鼻导管（P < 0.001）。与唯一的高流量鼻导管相比，床头抬高的额外干预使基于流量的呼吸暂停低通气指数显着降低了 12 个事件·h-1（95% CI，2 至 21；P = 0.022）。高流量鼻插管，单独或与床头抬高相结合，也改善了夜间氧合。没有观察到有害事件。结论 高流量鼻导管和上半身抬高的组合降低了 OSA 的严重程度和夜间低氧血症，表明它可以作为一种替代的术后气道管理策略。编辑的观点 结论 高流量鼻导管和上半身抬高的组合降低了 OSA 的严重程度和夜间低氧血症，表明它可以作为一种替代的术后气道管理策略。编辑的观点 结论 高流量鼻导管和上半身抬高的组合降低了 OSA 的严重程度和夜间低氧血症，表明它可以作为一种替代的术后气道管理策略。编辑的观点