ABSTRACT
Introduction: Covid-19 increased the burden on hospitals for patients with symptoms and potential vital complications. Patient home self-monitoring of clinical signs and physiological safety parameters using connected devices was assessed to better detect patients with indication of rehospitalization. Method(s): After clinical/PCR COVID confirmation, patients were given WITHINGS devices: Scanwatch, a thermometer, a blood pressure monitor, a Sleep analyzer and instructed to take measures twice a day with data retrieved on HealthMate app. Reports and questionnaires on clinical symptoms were sent daily to physicians. Result(s): Ten PCR positive patients were included (5 males): mean age 45.5years [31;67], BMI 26.9kg/m2 [19.7;43.2]. Main COVID symptoms were cough (33%), sore throat (27%), tiredness (36%), dyspnea (37%). Delay between COVID onset and self-monitoring start was 7.7days [0-37]. 8 patients had a good adherence to the protocol up to 30 days. SpO2 and Heart Rate (HR) were most frequently measured: 88 [5-177] and 58 [21-195] measures in average respectively. Five patients with polysomnography had Apnea-Hypopnea Index (AHI) equivalent to the Sleep analyzer averaged over several nights: AHISA: 8.53[-1;71.4] vs AHIPSG: 13.01[1.49;28.76]. Temperature remained within normal in 9/10 patients. In most patients Breathing rate (BR) decreased, HR decreased or remained steady, nigthtime HR/BR changed similarly. Daily steps increased throughout along with BR reduction. All patients had favorable outcomes without indication of hospitalization. Conclusion(s): Home self-monitoring during a pandemic is feasible. Safety parameters may be effectively monitored by patients and easily reported to their physicians.
ABSTRACT
Introduction: COVID-19 is a respiratory disease with clinical manifestation, severity, and outcomes heterogeneity, from asymptomatic presentation to an acute hypoxemic respiratory failure. Clinical characteristics and comorbidities may affect susceptibility to a more severe COVID-19. We hypothesize that obstructive sleep apnea (OSA) may be a significant factor that mitigates COVID-19 severity. Methods: A prospective multicentric cohort "Co-survivors" with a sample size of 400 patients was set and started recruiting in June 2020. Patients with a respiratory presentation of COVID-19 were selected. All severities of COVID-19 were allowed from outpatients to patients requiring prolonged invasive mechanical ventilation. At 3-months follow-up, patients underwent a cardio-respiratory clinical investigation. Initial and actual clinical manifestations and comorbidities were collected. All patients underwent a full polysomnography (PSG) or respiratory polygraphy (PG). Results: At the time of the analysis, 121 patients were included in the cohort. OSA was diagnosed before COVID-19 and already treated in 10 patients, and 23 were waiting for investigation. Full PSG was performed in 88 patients (80 PSG and 8 PG). OSA was absent in 15 (17%) patients, while mild, moderate, and severe OSA was present in 30 (34.1%), 21 (23.9%) and 22 (25%), respectively. Outpatient COVID-19 was reported in 30 (34.1%), hospitalization was needed without and with acute respiratory failure in 13 (14%) and 45 (51%) patients, respectivelly. These later were predominantly male and older, did not exhibit more comorbidity but metabolic characteristics with significant higher body mass index and waist circumference. Sleep recordings revealed an AHI of 7.4 [1.7;15.4], 15.7 [8.3;48.9] and 21.9 [14;35.1] p<0.01 in these three classes of COVID-19 severity, respectively. Finally, undiagnosed OSA was a factor of COVID-19 severity. Conclusions: Patients with OSA are highly represented in a population of COVID-19 survivors. About 10% of the patients were diagnosed prior to infection, undiagnosed moderate or severe OSA was diagnosed in 48.9% of the remaining patents. Moreover, OSA is likely to be a factor of acute respiratory failure in patients infected with SARS-CoV-2.
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Objective: Aim of the study is to investigate the impact of COVID-19 lockdown on trajectories of vascular stiffness among a large population of users of a connected bathroom scale, allowing reliable measurements of pulse wave velocity (PWV) Design and method: Pulse wave velocity (PWV) recordings obtained by Withings Heart Health & Body Composition Wi-Fi Smart Scale users before and during lockdown were analyzed. We compared two demonstrative countries: France who applied strict lockdown rules (n=26,196) and Germany, who applied partial lockdown (n=26,847). Subgroup analysis was conducted in users of activity trackers and home blood pressure monitors (HBPM). Linear growth curve modeling and clustering trajectories analyses were performed Results: During lockdown a signi ficant reduction in PWV, weight, BP and physical activity was observed in the overall population. PWV reduction was signi fi-cantly greater in France than in Germany, corresponding to an improvement of 5.2 months in vascular age In the French population three clusters of PWV trajectories were identi fied: decreasing (21.1%), stable (60.6%) and increasing PWV (18.2%). Decreasing and increasing PWV clusters had both higher PWV and vascular age at baseline compared to stable PWV cluster. Only decreasing PWV cluster showed a signi ficant weight reduction (-400 g), whereas living alone was associated with increasing PWV Conclusions: Total lockdown induced a reduction in vascular stiffness in a signi ficant proportion of French smart scale users. Impact on long term behaviors and cardiovascular health remains to be established.
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INTRODUCTION: Some COVID-19 patients develop respiratory failure requiring admission to intensive care unit (ICU). We aim to evaluate the effects of pulmonary rehabilitation (PR) post-ICU in COVID-19 patients. METHODS: Twenty-one COVID-19 patients were evaluated pre- and post-PR and compared retrospectively to a non-COVID-19 group of 21 patients rehabilitated after ICU admission due to respiratory failure. RESULTS: PR induced greater 6-min walking distance improvement in COVID-19 patients (+205 ± 121 m) than in other respiratory failure patients post-ICU (+93 ± 66 m). The sooner PR was performed post-ICU, the better patients recovered. CONCLUSIONS: PR induced large functional improvements in COVID-19 patients post-ICU although significant physical and psychosocial impairments remained post-PR.