Treatment-emergent central sleep apnea during high flow nasal cannula treatment in infants

<bold>Background:</bold> Treatment-emergent central sleep apnea (TECSA) has previously been described with treatment with CPAP for obstructive sleep apnea. High flow nasal cannula (HFNC) is often better tolerated than CPAP in infants and can be used in mild OSA. <bold>Aims:</bold> To report three infants who developed TECSA upon HFNC initiation. <bold>Method/Results:</bold> The polygraphy was performed around two months of age and manually scored according to the AASM scoring rules. In split night analysis: <bold>with</bold> <bold>HFNC</bold> apnea–hypopnea index (AHI), CAI and oxygen desaturation index (ODI) were 70, 55 and 76/h, respectively, and <bold>without HFNC</bold> the values were 15, 6 and 20/h. respectively, with similar results in the other two patients. Due to the clinical significant results, the HFNC treatment was discontinued. <bold>Conclusion:</bold> We conclude that there can be significant treatment-emergent central sleep apnea also during treatment with HFNC. We suggest a mandatory clinical follow-up after initiation of HFNC treatment. If there is a suspicion of TECSA, it is recommended to perform a sleep study. Further studies are warranted to elucidate the role of treatment-emergent central sleep apnea when using HFNC in infants. <bold>Figure 1.</bold> The upper part is a split-night polygraphy with an infant <bold>with</bold> HFNC showing a treatment-emergent central sleep apnea. The lower part is a polygraphy from the same infant during the same night <bold>without</bold> HFNC. <fig><object-id>erj;64/suppl_68/OA4659/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>