The study aims to compare the efficacy of Nasal High Flow Therapy (NHF) with low-flow oxygen
supplementation in improving postoperative intermittent desaturations. If so, this mode of
therapy would provide a cost effective, relatively easy to implement, and better tolerated
treatment to Continuous Positive Airway Pressure (CPAP) for oxygen stabilization.
Patients identified preoperatively with previously diagnosed obstructive sleep apnea
(intermittent collapse of upper airway while asleep) who refuse Continuous Positive Airway
Pressure use after surgery and are treated with routine postoperative supplemental oxygen
alone (1 liters per minute) will have more oscillation of oxygen saturation during the night
(measure by overnight oximetry) than those treated with high nasal flow air insufflator
(Fisher & Paykel Airvo 2 device) with same amount of oxygen supplement (1 liters per
1. Known diagnosis of obstructive sleep apnea by polysomnography (Apnea Hypopnea Index ≥
5 events per hour) with recommendation of Continuous Positive Airway Pressure use.
2. The patient declines use of Continuous Positive Airway Pressure for the upcoming
3. The patient will require more than 48 hours of hospitalization.
4. Informed consent obtained from patient or approved designate.
1. Predetermined need for Continuous Positive Airway Pressure post-operatively by
2. Body Mass Index ≥ 40.
3. Patient with congestive heart failure and diagnosis of Cheyne- Stokes respiration or
4. Patients who are oxygen dependent due to moderate to severe Chronic Obstructive
Pulmonary Disease (Available Forced Expiratory Volume at 1 second of < 50% predicted)
or advanced interstitial lung disease.
5. Preexisting chronic hypercapnia with known neuromuscular disease with respiratory
involvement (e.g. Amyotrophic Lateral Sclerosis, myopathy).
6. Severe anemia necessitating blood transfusion.
7. Presence of tracheostomy.
8. Naso-oral malformation or severe nasal septal defect.
9. Presence of dementia or other diagnosed neurodegenerative disease.
10. Non-English speakers
11. Inability to provide informed consent.