P53 CPAP supply challenges to UK Sleep centres in 2022

BackgroundContinuous Positive Airway Pressure (CPAP) therapy is the standard treatment for patients with Obstructive Sleep Apnoea (OSA). Significant recent challenges have affected CPAP supply worldwide: increased CPAP demand, interrupted logistics during the COVID pandemic, worldwide Field Safety Notice (2021), plus CPAP component shortages.MethodsTo understand the issues around CPAP delivery and supply, the OSA Alliance sent an email survey to all UK-based Sleep Centres listed on the Sleep Apnoea Trust database in February and again in June 2022.ResultsWe received replies from 22 (February) and 15 (June) UK centres, with 8 centres represented in both surveys.91% (February) and 67% (June) of respondents confirmed ongoing CPAP machine supply shortages. In February, centres were receiving on average 50% usual delivery versus 73% in June. In June, centres described CPAP supply during the past 6 months as: improved 47%, worsened 47%, same in 6%. In free text comments, humidifier shortage was also mentioned by some.Patients on the waiting list for CPAP varied between UK centres from 0–400 (February) and 0–260 (June). All centres with CPAP shortages were using the BTS Clinical Risk Stratification.1In February, patients with high clinical priority according to the risk stratification requiring urgent CPAP therapy could start this quickly (1–2 weeks) in all centres, but the average wait time to start routine CPAP was 13 weeks (range 2 to 40 weeks). In June, the average wait for routine CPAP was 13.3 weeks (range 2–52 weeks). In both surveys, the majority of centres (86% February and 67% June) said delays were due to CPAP supply, not staff shortages.ConclusionsOngoing CPAP supply issues have led to self-reported sleep centre delays in treatment for patients with OSA. CPAP supply appears highly variable between centres, meaning centres have searched for alternative suppliers;a time consuming task with teams not being trained on the respective CPAP models. A humidifier shortage contributes to difficulties that may impact on CPAP adherence. Specific resource allocation towards CPAP provision for patients with OSA is required to address these issues and improve compliance NICE evidence-based therapeutic guidance in the UK.The authors have produced this abstract on behalf of the OSA Alliance, UK.Referencehttps://www.brit-thoracic.org.uk/news/2021/national-patient-safety-alert/

DISTINCT SYMPTOM PROFILES IN CANCER SURVIVORS DURING COVID-19 ARE ASSOCIATED WITH POORER QUALITY OF LIFE (QOL) OUTCOMES

Introduction A substantial proportion of cancer survivors experience a relatively high symptom burden. During the COVID-19 pandemic, study purposes were to identify distinct symptom profiles in cancer survivors and evaluate for differences among these symptom profiles in QOL outcomes. Methods Survivors (n=1145) completed questionnaires that evaluated: depression, state anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive impairment, and pain. QOL was assessed using the QOL Scale-Patient Version. Latent profile analysis was used to identify distinct symptom profiles (i.e., latent classes) using the severity scores from each of the symptom measures. Differences in QOL scores were evaluated using analysis of variance. Results Four distinct symptom profiles were identified (i.e., none (28.6%), low (37.7%), high (25.9%), very high (7.9%)). Compared to the none class, survivors in the other three classes were younger, more likely to be female, had a higher comorbidity burden, and a poorer functional status. Differences among the four classes in physical, psychological, social, and spiritual well-being, as well as total QOL scores followed the same pattern (none > low > high > very high). Conclusions Findings suggest that almost 35% of cancer survivors were experiencing a high to very high symptom burden during the COVID-19 pandemic. As symptom burden increased in these survivors, decrements in QOL increased in a stepwise fashion.

DISTINCT STRESS AND LONELINESS PROFILES ARE ASSOCIATED WITH A HIGHER SYMPTOM BURDEN IN CANCER SURVIVORS DURING COVID-19

Introduction High levels of stress are common during the COVID-19 pandemic. Less is known about levels of stress in cancer survivors. Study purposes were to identify distinct stress profiles in cancer survivors and evaluate for differences among these stress profiles in symptom burden. Methods Survivors (n=1145) completed stress, social isolation, and loneliness questionnaires to determine the stress profiles (i.e., latent classes), using latent profile analysis. Differences in common symptoms (i.e., depression, anxiety, fatigue, sleep disturbance, cognitive impairment, pain) were evaluated using parametric and non-parametric tests. Results Four distinct stress profiles were identified (i.e., none (51.3%), low stress and high loneliness (24.4%), high stress and high loneliness (14.0%), very high stress and very high loneliness (10.3%)). While loneliness scores were high, social isolation scores did not exceed the clinically meaningful cut point. Significant differences were found among the four classes in the severity of depression, anxiety, morning fatigue, cognitive impairment, and pain interference. Compared to none class, the other three classes reported higher sleep disturbance and evening fatigue scores. Conclusions Findings suggest that COVID-19 pandemic-associated stress and loneliness are experienced differently across a large sample of cancer survivors. Higher levels of stress and loneliness are associated with a significantly higher symptom burden.

Transmission of SARS-COV-2 in the hospital setting: Who is infecting whom?

Introduction: A better understanding of the relative importance of different transmission pathways of SARS-CoV-2 in hospital settings has the potential to help improve targeting of control measures aimed at reducing nosocomial spread. Objectives: To quantify the associations between risks of nosocomial SARS-CoV-2 infection and exposure on the same ward to infected healthcare workers (HCWs), to patients likely to have been infected nosocomially, and to patients with community onset COVID-19. Methods: Ward-level data were collected from four teaching hospitals in Oxfordshire, UK, over an 8 month period in 2020. SARS-CoV-2 infections were identified using both PCR results from symptomatic and asymptomatic testing and serological data coupled with symptom recall. A series of statistical models were used to quantify associations between exposures and probable hospital transmission events. Results: Risk to patients of probable nosocomial acquisition was most strongly associated with exposure to other patients with hospitalacquired SARS-CoV-2 (aOR, 1.76, 95%CI 1.51, 2.04), followed by the presence of an infected HCW on the same ward (aOR 1.45, 95%CI 1.22,1.71). The association with patients with community onset COVID- 19 was weaker (aOR 1.12, 95%CI 0.96,1.26). Transmission to HCWs was associated with exposure to other infectious HCWs and patients with hospital-acquired SARS-CoV-2 (aOR 1.66, 95%CI 1.55,1.78 and aOR 1.45, 95%CI 1.32,1.58 respectively). The introduction of more stringent infection prevention and control measures which included testing all patients for SARS-CoV-2 by PCR on admission and at weekly intervals was associated with substantial reduction in transmission risk to both patients (adjusted odds ratio, aOR 0.25, 95%CI 0.14, 0.42) and HCWs (aOR 0.43, 95%CI 0.34, 0.53). Conclusion: Patients who acquired SARS-CoV-2 in the hospital and, to a lesser degree, infectious HCWs likely working prior to the onset of symptoms, were the most strongly associated with increased risk of SARSCoV- 2 transmission. In contrast, exposure to patients who had acquired SARS-CoV-2 in the community was associated with, at most, modest increases in the daily risk of infection for both healthcare staff and the other patients.