Home sleep apnea testing in the era of COVID-19: a community perspective

Abstract

Sleep medicine programs in the New York City metropolitan area mostly suspended operations near the start of the COVID-19 pandemic surge in the Northeast; the last diagnostic sleep study in our group was completed on March 16, 2020. Our private practice multispecialty group of more than 800 providers relies on sleep medicine consultation, diagnostic testing, and treatment of sleepdisordered breathing to optimize health care delivery. This suite of services is particularly important for our population with obesity, for whom COVID-19 may carry a higher risk of morbidity and mortality, 1 a noteworthy observation echoed in my own experience working in the intensive care unit at our community hospital. The challenge is how to restart sleep services in a manner that is objectively safe and reassuring to patients and our referring providers. Specifically, we have addressed the screening of sleep referrals for COVID-19 signs and symptoms, the distribution of home sleep apnea testing (HSAT) devices, and the return of HSAT devices with disinfection for reuse.Consistent with American Academy of Sleep Medicine recommendations, 2 telephone screening is completed before all HSAT visits for COVID-19 symptoms, including fever, cough, and shortness of breath. Patients are again screened for COVID-19 symptoms and a noninvasive temperature check is completed upon arrival for HSAT education and device pickup. Medical staff are screened similarly on a daily basis and are required to wear personal protective equipment with every patient.Our sleep center's specific challenge has been to develop a process to minimize any risk of transmission of COVID-19 via contact with HSAT equipment. We communicated with 5 major manufacturers of HSAT devices (

Sleep disorders and COVID-19

“…Manufacturers of HSAT equipment recommend quaternary alcohol-based cleaning following Centers for Disease Control and Prevention (CDC) guidance, which is not specific to HSAT equipment. No specific changes in the disinfection process for HSAT devices has been recommended by manufacturers [ 105 ]. The AASM recommends waiting 72 hours between the reuse of HSAT devices based on data for SARS-CoV-2 surface stability on plastic surfaces [ 106 ].…”

Sleep Dysfunction in COVID-19 Patients: Prevalence, Risk Factors, Mechanisms, and Management

“…Various societies have issued guidelines regarding the safe function of sleep laboratories for the diagnosis and treatment of sleep disorders [75][76][77][78][79][80][81][82] and infection prevention [77]. Each sleep laboratory should adapt according to the local prevalence of COVID-19, increasing the levels of precautions when the community spread is high.…”

“…Each sleep laboratory should adapt according to the local prevalence of COVID-19, increasing the levels of precautions when the community spread is high. Home sleep testing is preferred, and in-laboratory polysomnography should be performed on urgent and high-risk patients with disposable probes when available [78]. Symptoms and contact history for COVID-19 should be assessed in the case of an in-person appointment in the sleep laboratory with appropriate protective equipment such as surgical or FFP2 masks and gloves used.…”

Sleep laboratories reopening and COVID-19: a European perspective

“…This is a considerable limitation, especially if one considers the usual high demand of diagnostic sleep tests, possibly increased by the long interruption of sleep services. Low-cost ultraviolet C-machines have been proposed to sterilise non-disposable equipment [ 9 ] in alternative to standard hospital sanitisation procedures.…”