Sleep testing during the pandemic.

BACKGROUND: The COVID-19 pandemic disrupted the U.S. healthcare system, reducing the capacity available for unrelated conditions, such as sleep disordered breathing, and increasing concerns about the safety of in-lab testing. This study characterizes how the pandemic impacted the assessment of sleep disordered breathing and use of associated services. METHODS: Sleep testing claims occurring between January 2019 and June 2021 were extracted from the database of a national healthcare organization. Utilization was trended. Logistic regressions were run to assess the association between quarter of initial testing, whether testing was followed by treatment, and whether testing was followed by a clinical visit with a diagnosis related to sleep apnea, after controlling for patient-related factors. A Cox proportional hazards model assessed factors influencing time to treatment. Finally, a logistic regression assessed factors influencing the finality of home-based testing. RESULTS: In Q2 2021, home-based testing utilization was 134% of its initial level, while in-lab and split night testing were both at 61% of initial levels. Patients receiving initial home-based testing did not significantly differ in their likelihood of treatment, but were significantly less likely to have a clinical visit for sleep apnea (P < 0.01). Patients initially tested in 2021 were treated significantly more quickly than those initially tested in Q1 2019. Home-based testing occurring in Q4 2019 or later was significantly more likely to be definitive than home-based testing occurring Q1 2019. CONCLUSIONS: Home-based sleep testing increased significantly and durably in 2020, and was associated with faster time to treatment than initial in-lab testing.

Guidelines of the Indian Society for Sleep Research (ISSR) for Practice of Sleep Medicine during COVID-19.

BACKGROUND: Sleep services are assigned a non-essential status during COVID-19. The American Academy of Sleep Medicine strongly urges sleep clinicians to continue postponing non-urgent care until a later date, if such a recommendation is made by state officials due to local conditions. At the same time, one cannot ignore the fact that sleep is important for people's health and wellbeing. Therefore, to protect the health of the population, it is essential to find ways and means to continue the practice of sleep medicine even during the COVID-19 pandemic. METHOD: Social environment and work ethics in sleep clinics and sleep laboratories in Asia, Africa, and Latin America are different from those in the US. Under these circumstances, the Indian Society for Sleep Research (ISSR) created a task force to develop guidelines for the practice of sleep medicine, not only for the Indian environment but also for other countries that are affected by the COVID-19 pandemic. The task force examined documents regarding practice of sleep medicine and associated specialities  during COVID-19 by various professional organizations and governmental authorities. The recommendations were examined for their applicability. Wherever gaps were identified, consensus was reached keeping in view the available evidences. OUTCOME AND RECOMMENDATIONS: The emphasis of the guidelines is on avoiding doctor to patient contact during the pandemic. Teleconsultation and other modes of audio-visuals can be used as modes for medical practice during the COVID-19 pandemic. However, in addition to the patient, the presence of a family member, or a reliable informant is recommended. Patients of most sleep disorders can be provided tele-aftercare service. ISSR guidelines also give a list of medications allowed to be prescribed during the first and the follow-up teleconsultation. Hospitals and clinics are slowly opening in India and many other countries. As sleep services resume operations, there is a need to find innovative ways to reduce contact with COVID-19 patients, follow personal protection guidelines, as well as social distancing. This article does discuss strategies for the safe conduct of Level 1 sleep studies. Home sleep testing, which had greater acceptance during the last few years, should be given more attention during the COVID-19 period. Once the decision to reopen the sleep laboratory and resume operations is made, the safety of the patients and office staff should become the major priority. The ISSR recommendation is to postpone and reschedule in-laboratory positive pressure therapy, but it mentions the considerations to be followed in emergency situations. At the same time, high clinical risk patients may be diagnosed on the basis of clinical findings, and without performing polysomnography or home sleep testing. However, at some point, there is a need to reinitiate the in-lab testing. In addition, daily assessment of the COVID-19 situation in the community, along with a review of the situation with local public health and the state health department is advised.

[Expert consensus on sleep study and non-invasive positive airway pressure therapy during the epidemic of coronavirus disease 2019].

Coronavirus disease (COVID-19) is mainly transmitted through respiratory droplets, close unprotected contact, and intense aerosols-generating procedures. Sleep study and non-invasive positive airway pressure (NIPAP) therapy can increase the risk of exposure and transmission of new coronaviruses to medical staff and patients. China's national epidemic control has entered a critical stage of overall prevention and control together with the restoration of normal medical care delivery. Based on the characteristics of sleep-disordered breathing, this consensus elaborates on the recommendations from the following four aspects that include patient and medical staff education, optimization of diagnostic and treatment protocols, sterilization of medical devices and the environment, and control of hospital-acquired infection. It is emphasized that the indications for sleep study and NIPAP should be strictly defined according to the local epidemic situation. Portable home sleep study and auto-titration positive airway pressure is recommended. The applications of disposable nasal pressure transducer for sleep study and disposable or personal masks and ventilator tubing for NIPAP are strongly suggested. Moreover, it is necessary to standardize the procedure of NIPAP, to separate the functional divisions in sleep lab, to comply with the protection regulations for medical personnel, and to strengthen the cleaning and disinfection management.