1191 A Pediatric Case of Treatment Emergent Central Sleep Apnea During High Flow Nasal Cannula Polysomnography

Abstract Introduction High flow nasal cannula (HFNC) is an alternative therapy to continuous positive airway pressure (CPAP) in pediatric populations with behavioral intolerance or contraindications to CPAP. Studies evaluating HFNC as a treatment modality in the pediatric literature have been limited. Report of case(s) A previously healthy 12-year-old male with a history of obesity presented with partial and full thickness burns to his face, neck, chest, and bilateral upper-extremities following a bonfire accident. His burns covered 15% of his total body surface area. He required hospitalization for acute burn management and skin grafting. During his hospitalization, he was observed to have snoring, witnessed apneas, and nocturnal hypoxemia concerning for underlying obstructive sleep apnea. He was unable to utilize a non-invasive positive pressure mask interface due to his extensive facial dressings and pressure sensitive skin grafts. He was discharged home on high flow nasal cannula at 10-15 Liters/minute. The patient experienced weight gain following hospitalization, possibly related to Cyproheptadine use for burn-related itching. Approximately 10 months after discharge, the patient underwent split-night HFNC polysomnography. The diagnostic portion of his study revealed severe obstructive sleep apnea with an OAHI of 28.8 events/hour. There were no observed central or mixed respiratory events and no REM stage sleep during the diagnostic portion of the study. After initiating HFNC at 40 L/minute and 34 degrees Celsius per sleep laboratory protocol, the OAHI decreased to 0.0 events/hour despite REM rebound, and the CAHI increased to 16.8 events/hour. This study was conducted at approximately the same altitude as the patient’s home. Conclusion This patient experienced treatment emergent central sleep apnea during HFNC polysomnography. Treatment emergent central sleep apnea with HFNC has previously only been described in a limited number of pediatric patients with underlying chronic lung disease, developmental delay, or genetic syndromes. This case highlights HFNC as an alternative treatment modality to CPAP as well as the need for further understanding of HFNC titration in pediatric sleep laboratories. Support (if any) The Breathing Institute at Children’s Hospital Colorado