OSA patients' opinions concerning their disease and treatment during the pandemic

The COVID-19 pandemic has changed the operation of healthcare systems worldwide reducing hospital based services, and increasing telemedicine solutions for the diagnosis and treatment of obstructive sleep apnoea (OSA). Aim(s): to evaluate the opinion of OSA patients concerning their disease during the COVID pandemic,their treatment and follow up. Method(s): A telephone questionnaire based survey was conducted on OSA patients treated with CPAP including basic information (age, gender, marriage, education level, etc.), opinion towards the changes of medical practice during the pandemic, history of OSA, Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), DAR-5 (anger), PHQ-4(depression and anxiety), Heaviness of Smoking Index (HSI) and Loneliness scale (LS). Adherence on CPAP was assessed objectively by telemonitoring. Result(s): 100 OSA patients 54.3+/-12.5 years (72% males) were evaluated presenting with ESS: 4.3+/-2.95, AIS: 3.14+/-3.3, PHQ-4: 2.29+/-1.72, DAR-5: 6.7+/-1.95 and HSI 3.5+/-.1.7. Mean CPAP use was 5.8+/-1.65 with 2.9+/-2.5years OSA history (96% used CPAP the same as before the pandemic). 41% considered themselves as high risk group for severe disease due to COVID because they suffered from OSA, and 25% believed CPAP could be protective from COVID. Patients infected with COVID (31%) did not change their CPAP use. 30% believed they received worse healthcare facilities than before and 16% presented worse sleep quality. Conclusion(s): During the pandemic, OSA patients continued to use their CPAP as before;however they believed that they should have better healthcare facilities. They considered themselves as a high risk group for COVID infection.

Healthcare professionals' sleep and mental stress during the two first consecutive waves of COVID-19 in northern greece

Objectives/Introduction: In December 2019, a novel corona virus was identified (COVID-19). Healthcare Professionals (HCPs) experience high levels of stress and irregular work schedule, with frequent work shifts leading to increased sleep disturbances especially during the pandemic. This study aimed to assess the impact of COVID-19 on the healthcare workers' sleep and mental stress during two consecutive epidemic waves in northern Greece. Method(s): An online cross-sectional, anonymized, self-reported questionnaire survey was conducted in May 2020 (first epidemic wave) and then was repeated in December 2020 (second epidemic wave), including basic information (age, gender, marriage, education level, etc.), contact with COVID-19 patients, quarantine status, current physical condition, Sleep Condition Indicator (SCI), DAR-5 (anger), PHQ-4(depression and anxiety), Heaviness of Smoking Index (HSI) and Loneliness scale (LS). Statistical analysis was performed using the SPSS (version-20 IBM, NY, USA). Continuous variables were presented as mean+/-SD and categorical variables as number (%). p < 0.05 was accepted as statistically significant. To separate parametric from non-parametric variables normality tests using the Kolmogorov- Smirnov test were performed. For the detection of statistically significant differences when comparing the results of a continuous variable between the two waves, the independent-samples-T-test and the Mann-Whitney-U-test were used for parametric and non-parametric variables respectively. Result(s): 1044 HCPs answered (males/females 47%/53%) 79% doctors with mean age 45.2 +/- 11.1 years. During the second wave HCPs presented worse sleep quality (SCI 23.7 +/- 6.7 vs.26.4 +/- 5.7, p < 0.001), worse PHQ-4 (4.4 +/- 2.9 vs. 2.8 +/- 2.3, p < 0.001), increased anger (DAR-5 9.2 +/- 3.8 vs.7.7 +/- 2.6, p < 0.001) and loneliness (LS 5.8 +/- 1.9 vs. 5 +/- 1.6, p < 0.001). The smoking status and HIS did not change during the two waves. A negative correlation was found between SCI - PHQ-4, SCI-DAR-5 and SCI- LS, especially during the second wave. Conclusion(s): Changes in sleep quality were observed in health professionals, especially during the second wave. Sleep quality, anger, depression, anxiety and loneliness were negatively affected during the progression of the pandemic.

Transient post ictal fever: An infrequent symptom

Background and aims: Fever is a response to stimuli leading to the deregulation of the central thermostatic control. It is well-known that hyperthermia is a significant seizure-inducing factor, but it is unusual to be observed in the post-ictal period. Methods: We present the case of a 41-year-old man, admitted to our Department due to multiple generalized convulsions since the early hours on the day of admission. He had a 20-year history of epileptic seizures, after sustaining head trauma in a car accident. He was taking valproate long-term, with poor adherence, and carbamazepine for 6 months. On admission the patient had full consciousness, and the neurological examination, blood pressure and blood glucose test were normal. His body temperature was 38.8C. Results: An infectious cause of fever was investigated. A complete laboratory and imaging examination (WBC, ESR, CRP, liver biochemical tests, blood and urine cultures, PCR for SARS-CoV-2, CXR) was performed. Tests returned normal or negative, ruling out an infection. Brain CT revealed a porencephalic lesion on the left occipital lobe and signs of a craniotomy on the right temporal side. EEG showed slow theta activity in the left temporo-occipital area. The fever resolved spontaneously in about 12 h. Conclusions: Fever is a well-known seizure-inducing factor, but an infrequent condition in post-ictal period. It is hypothesized that this symptom is a consequence of peri-ictal repetitive muscular contractions and disturbance of homeostasis in generalized convulsive seizures. It also seems possible that the upregulation of the hypothalamic thermoregulatory center can produce it. The investigation for infectious causes is necessary.