ABSTRACT
STUDY OBJECTIVES: To analyze the impact of national lockdowns in Greece on positive airway pressure (PAP) adherence, patients' perspectives regarding COVID-19 pandemic and the role of telemedicine. METHODS: 872 obstructive sleep apnea (OSA) patients from Southern and 673 from Northern Greece, under PAP treatment, were evaluated with adherence data available 12 months prior to and 3 months after the first and second lockdown. Telemedicine, locally available as part of a research protocol, was used for patient's follow-up in Southern Greece and standard follow up procedures were implemented in Northern Greece. We analyzed the impact of COVID-19 lockdown on PAP adherence, and patients concerns regarding COVID-19 infection. RESULTS: Significant difference was noted in PAP adherence as measured by the hours of use at 12 months prior to and at the 3 months after the first lockdown in Southern (5.6 vs 6.6, p=0.003) and Northern Greece (5.3 vs 6.0, p=0.03). The proportion of patients with optimal adherence (≥6 hours) increased by 18% (p=0.004) in Southern and by 9% (p=0.20) in Northern Greece after the first lockdown and remained steady after the second lockdown in both groups. In Southern Greece, 23% of patients reported that they were concerned about getting COVID-19 due to OSA diagnosis, while only 3% reported decreased sleep duration. Moreover, 9% were concerned that the presence of OSA would make them more susceptible for worse outcome in case of COVID-19 infection. CONCLUSIONS: Our results suggest that maintaining follow-up using telemedicine had a positive influence pointing out the potential role of digital health.
ABSTRACT
Clinical activities regarding sleep disordered breathing (SDB) have been sharply interrupted during the initial phase of the coronavirus disease 2019 (COVID-19) epidemic throughout Europe. In the past months, activities have gradually restarted, according to epidemiological phase of COVID-19 and national recommendations. The recent increase in cases throughout Europe demands a reconsideration of management strategies of SDB accordingly. Diagnosis of SDB and initiation of treatment pose some specific problems to be addressed to preserve the safety of patients and health personnel. This perspective document by a group of European sleep experts aims to summarise 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 is likely to change in the near future, and use of telemedicine will grow to avoid unnecessary risks and continue to provide optimal care to patients. In addition, the document covers paediatric 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.