Continuum of care for patients with obstructive sleep apnea after one year from the COVID-19 pandemic onset: no time for further delays

Abstract

Since the SARS-CoV-2 pandemic onset, many routine medical activities have been put on hold and this has deeply affected the management of patients with chronic diseases such as obstructive sleep apnea. Untreated OSA is associated with increased mortality and difficulties in social functioning. A delay in initiating treatment may therefore have harmful consequences. Between February and April 2020, the so-called first wave of the pandemic, the overall activity of sleep centers in Europe was reduced by 80%. As the international infection control authorities released guidelines for SARS-CoV-2 outbreak control, many of the national sleep societies provided strategies for a gradual re-opening of sleep facilities. Most of these strategies were not evidences-based and, in a climate of general concern, worldwide it was strongly advised to post-pone any non-urgent sleep-related procedure. Despite the initial idea that the outbreak could be transient, after one year it is still ongoing and the price we are paying, not only includes deaths caused by COVID-19, but also deaths caused by missed or late diagnosis. As further delays in diagnosing and treating patients with sleep apnea are no more acceptable, a new arrangement of sleep facilities and resources, in order to operate safely and effectively, is now mandatory. In this article, we review most recent literature and guidelines in order to provide practical advice for a new arrangement of sleep laboratories and the care of patients with obstructive sleep apnea after one year from the onset of the COVID-19 pandemic.

Did COVID-19 impact Positive Airway Pressure adherence in 2020? A cross-sectional study of 8477 patients with sleep apnea

“…As recently underlined by a perspective article [7] and a review article [8], whether the COVID-19 pandemic impacts PAP adherence over the long-term is unknown and only preliminary data on the initial 4 weeks of the first lockdown have been reported [9][10][11]. With the aim of describing the impact of the first and second waves of COVID-19 on PAP adherence during 2020 in France, we designed a cross-sectional study of SA patients under PAP telemonitoring and compared 2020 versus 2019 PAP adherence.…”

Factors Associated with the Underestimation of Manual CPAP Titration Pressure

“…However, in patients with severe rhinitis or a severe psychiatric or medical disease such as congestive heart failure or significant lung disease, unattended home titration with automatic devices is not recommended; thus, in-laboratory PSG titration is still regarded as the gold standard method of treatment [15]. Moreover, under certain conditions, such as while the SARS-CoV-2 pandemic was ongoing, in-laboratory CPAP titration was considered an aerosol-generating procedure and was not recommended [21]. If CPAP titration during the pandemic appears necessary under certain conditions, the negative screening of COVID-19 patients, the provision of personal protective equipment to protect workers in the laboratory, and a proper cleaning of the environment is required.…”

When the tongue runs out of gas

“…It is estimated that between 5 and 15% of the general population in the United States has OSA ( Lévy et al, 2015 ), and the incidence of OSA increases with obesity, likely because fat deposits on the wall of the pharynx cause it to narrow ( Carter and Watenpaugh, 2008 ). The standard treatment for OSA is continuous positive airway pressure (CPAP), which involves wearing a special face mask connected to a machine that pressurizes the pharynx to widen it during sleep ( Spicuzza and Sanna, 2021 ). Unfortunately, CPAP is uncomfortable and loud, and patients often do not use their CPAP machines consistently ( Al-Abri et al, 2020 ).…”