Sleep laboratories reopening and COVID-19: a European perspective

Abstract

The clinical activities regarding sleep disordered breathing (SDB) have been sharply interrupted during the initial phase of the COVID-19 epidemic throughout Europe. In the last months, activities have gradually restarted, according to epidemiological phase of COVID-19 and National recommendations. The recent increase in cases throughout Europe obliges to reconsider management strategies of SDB accordingly. Diagnosis of SDB and initiation of treatment pose some specific problems to be addressed to preserve safety of the patients and health personnel. This perspective document by a group of European sleep experts aims at summarising some different approaches followed in Europe and United States, which reflect National recommendations according to the epidemiological phase of the COVID-19 infection. Respiratory sleep medicine will likely change in the near future, and use of telemedicine will grow to avoid unnecessary risks and continue to provide optimal care to the patients. The document also covers pediatric sleep studies and indications for titration of noninvasive ventilation, as well as precautions to be followed by patients who are already on positive airway pressure treatment. A single consensus document developed by the European Respiratory Society and National Societies would be desirable to harmonise SDB management throughout Europe.

Sleep Telemedicine Practices: Checkpoint List and Practical Considerations in the COVID-19 Era

“…Moreover, sleep centers should be prompted to provide specific guidance with the various e-communications for their OSA patients, who are diagnosed with COVID-19, and stay updated with the current recommendations regarding medical services during the pandemic. Specific recommendations are outlined elsewhere (1,11) and briefly include self-isolation and continued use of their PAP treatment, preferably a non-vented mask, placement of exhalation filter, and avoidance of humidifier, to minimize the risk of PAP-induced droplet transmission.…”

Recomendaciones para la realización de estudios de sueño pediátricos durante la pandemia covid-19

“…Para lograr este objetivo se propone: Que todo el personal de la salud que trabaja en las US sea capacitado adecuadamente en el diagnóstico y tratamiento de la neumonía causada por COVID-19, antes de ingresar solicitar al paciente diligenciar un cuestionario de tamizaje (Tabla 1) (28).…”

“…En la fase de mitigación del COVID-19, en las US se pueden realizar estudios de forma progresiva en clínicas ambulatorias y hospitalarias (28,(39)(40)(41).…”

“…No se recomienda realizar estudios de titulación de CPAP o cánulas nasales de alto flujo (CAF) durante esta fase. En su lugar, se sugiere que la titulación se haga en casa (autoCPAP o CAF con oximetría) (28,(41)(42)(43)(44)(45)(46).…”

“…No se recomienda suspender el uso en casa de CPAP, BIPAP o CAF debido al riesgo de descompensación (28,43).…”