Snoring may transmit infectious aerosols from the upper to the lower respiratory tract

Bax, Ad; Shen, Yang; Kakeshpour, Tayeb; Fennelly, Kevin P.

doi:10.1016/j.mehy.2022.110966

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…Particles ≤ 5 µm are often considered most relevant to disease transmission because this size represents the cutoff for entering the deep lung, where infection causes pneumonia, which is associated with severe disease [46,47]. However, the now almost universally present Omicron variants of SARS-CoV-2 promote infection of the upper respiratory tract, from where they can enter the lungs through micro-aspiration [48] or, speculatively, snoringgenerated aerosols of upper respiratory tract fluids [49]. Therefore, the deposition of the larger particles in the upper respiratory tract, including the trachea and the bronchi, can represent an effective infection mechanism.…”

Section: Impact On Disease Transmissionmentioning

confidence: 99%

Resolving the Loss of Intermediate-Size Speech Aerosols in Funnel-Guided Particle Counting Measurements

Kakeshpour,

Bax

2024

Atmosphere

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Modeling of airborne virus transmission and protection against it requires knowledge of the amount of biofluid emitted into the atmosphere and its viral load. Whereas viral concentrations in biofluids are readily measured by quantitative PCR, the total volume of fluids aerosolized during speaking, as measured by different researchers using various technologies, differs by several orders of magnitude. We compared collection methods in which the aerosols first enter into a low-humidity chamber either by direct injection or via commonly used funnel and tubing arrangements, followed by standard optical particle sizer measurement. This “collect first, measure later” approach sacrifices the recording of the temporal correlation between aerosol generation and sound types such as plosives and vowels. However, the direct-injection mode prevents inertia deposition associated with the funnel arrangements and reveals far more intermediate-size (5–20 μm in diameter) particles that can dominate the total mass of ejected respiratory aerosol. The larger aerosol mass observed with our method partially reconciles the large discrepancy between the SARS-CoV-2 infectious dose estimated from superspreader event analyses and that from human challenge data. Our results also impact measures to combat airborne virus transmission because they indicate that aerosols that settle faster than good room ventilation rates can dominate this process.

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Section: Impact On Disease Transmissionmentioning

confidence: 99%

Resolving the Loss of Intermediate-Size Speech Aerosols in Funnel-Guided Particle Counting Measurements

Kakeshpour,

Bax

2024

Atmosphere

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“…This dropletgenerating mechanism was demonstrated to be highly productive for speech [12] but also is active during snoring. Because the inspired snoring airstream carries the particles first into the lung where they are inaccessible to traditional aerosol detectors, they could only be observed by generating an unnatural expiratory snoring sound [13]. Yet, following a regular inspiratory snoring sound, not all snoring-generated droplets "rain out" in the lung, and the fraction that remains airborne can be observed in subsequently exhaled breath.…”

Section: Introductionmentioning

confidence: 99%

Snoring-generated fluid droplets as a potential mechanistic link between sleep-disordered breathing and pneumonia

Kakeshpour,

Fennelly,

Bax

2024

Respir Res

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The soft palate and back of the throat represent vulnerable early infection sites for SARS-CoV-2, influenza, streptococci, and many other pathogens. We demonstrate that snoring causes aerosolization of pharyngeal fluid that covers these surfaces, which previously has escaped detection because the inspired airstream carries the micron-sized droplets into the lung, inaccessible to traditional aerosol detectors. While many of these droplets will settle in the lower respiratory tract, a fraction of the respirable smallest droplets remains airborne and can be detected in exhaled breath. We distinguished these exhaled droplets from those generated by the underlying breathing activity by using a chemical tracer, thereby proving their existence. The direct transfer of pharyngeal fluids and their pathogens into the deep lung by snoring represents a plausible mechanistic link between the previously recognized association between sleep-disordered breathing and pneumonia incidence.

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Inactivation of virions in host particles in air using 222- and 254-nm UV: Dependence of shielding on particle size and UV wavelength

Hill,

Doughty,

Mackowski

2024

Aerosol Science and Technology

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Snoring may transmit infectious aerosols from the upper to the lower respiratory tract

Cited by 3 publications

References 44 publications

Resolving the Loss of Intermediate-Size Speech Aerosols in Funnel-Guided Particle Counting Measurements

Resolving the Loss of Intermediate-Size Speech Aerosols in Funnel-Guided Particle Counting Measurements

Snoring-generated fluid droplets as a potential mechanistic link between sleep-disordered breathing and pneumonia

Inactivation of virions in host particles in air using 222- and 254-nm UV: Dependence of shielding on particle size and UV wavelength

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