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1.
JAMA Netw Open ; 4(11): e2134241, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1508587

ABSTRACT

Importance: The influence of sleep-disordered breathing (SDB) and sleep-related hypoxemia in SARS-CoV-2 viral infection and COVID-19 outcomes remains unknown. Controversy exists regarding whether to continue treatment for SDB with positive airway pressure given concern for aerosolization with limited data to inform professional society recommendations. Objective: To investigate the association of SDB (identified via polysomnogram) and sleep-related hypoxia with (1) SARS-CoV-2 positivity and (2) World Health Organization (WHO)-designated COVID-19 clinical outcomes while accounting for confounding including obesity, underlying cardiopulmonary disease, cancer, and smoking history. Design, Setting, and Participants: This case-control study was conducted within the Cleveland Clinic Health System (Ohio and Florida) and included all patients who were tested for COVID-19 between March 8 and November 30, 2020, and who had an available sleep study record. Sleep indices and SARS-CoV-2 positivity were assessed with overlap propensity score weighting, and COVID-19 clinical outcomes were assessed using the institutional registry. Exposures: Sleep study-identified SDB (defined by frequency of apneas and hypopneas using the Apnea-Hypopnea Index [AHI]) and sleep-related hypoxemia (percentage of total sleep time at <90% oxygen saturation [TST <90]). Main Outcomes and Measures: Outcomes were SARS-CoV-2 infection and WHO-designated COVID-19 clinical outcomes (hospitalization, use of supplemental oxygen, noninvasive ventilation, mechanical ventilation or extracorporeal membrane oxygenation, and death). Results: Of 350 710 individuals tested for SARS-CoV-2, 5402 (mean [SD] age, 56.4 [14.5] years; 3005 women [55.6%]) had a prior sleep study, of whom 1935 (35.8%) tested positive for SARS-CoV-2. Of the 5402 participants, 1696 were Black (31.4%), 3259 were White (60.3%), and 822 were of other race or ethnicity (15.2%). Patients who were positive vs negative for SARS-CoV-2 had a higher AHI score (median, 16.2 events/h [IQR, 6.1-39.5 events/h] vs 13.6 events/h [IQR, 5.5-33.6 events/h]; P < .001) and increased TST <90 (median, 1.8% sleep time [IQR, 0.10%-12.8% sleep time] vs 1.4% sleep time [IQR, 0.10%-10.8% sleep time]; P = .02). After overlap propensity score-weighted logistic regression, no SDB measures were associated with SARS-CoV-2 positivity. Median TST <90 was associated with the WHO-designated COVID-19 ordinal clinical outcome scale (adjusted odds ratio, 1.39; 95% CI, 1.10-1.74; P = .005). Time-to-event analyses showed sleep-related hypoxia associated with a 31% higher rate of hospitalization and mortality (adjusted hazard ratio, 1.31; 95% CI, 1.08-1.57; P = .005). Conclusions and Relevance: In this case-control study, SDB and sleep-related hypoxia were not associated with increased SARS-CoV-2 positivity; however, once patients were infected with SARS-CoV-2, sleep-related hypoxia was an associated risk factor for detrimental COVID-19 outcomes.


Subject(s)
COVID-19 , Cause of Death , Hospitalization , Severity of Illness Index , Sleep Apnea Syndromes/complications , Aged , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , Case-Control Studies , Continuous Positive Airway Pressure , Delivery of Health Care, Integrated , Extracorporeal Membrane Oxygenation , Female , Florida , Hospital Mortality , Humans , Hypoxia , Logistic Models , Male , Middle Aged , Odds Ratio , Ohio , Respiration, Artificial , Risk Factors , SARS-CoV-2 , Sleep , Sleep Apnea Syndromes/pathology , Sleep Apnea Syndromes/therapy
2.
Zhonghua Yi Xue Za Zhi ; 101(22): 1635-1637, 2021 Jun 15.
Article in Chinese | MEDLINE | ID: covidwho-1270141

ABSTRACT

Since the outbreak of coronavirus disease 2019 (COVID-19), the diagnosis and treatment of diseases has been greatly affected. Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common chronic disease, whose diagnosis and treatment methods have changed dramatically during the epidemic period-from traditional outpatient diagnosis and treatment to online remote diagnosis and treatment based on Internet. The diagnostical capability of major sleep centers has increased instead of decreasing. But with the change of diagnosis and treatment mode, privacy, data security, medical insurance policy and other related issues also emerge as the times require. Under the normalization of epidemic situation, telemedicine not only creates new opportunities, but also faces unprecedented challenges.


Subject(s)
COVID-19 , Epidemics , Sleep Apnea Syndromes , Sleep Apnea, Obstructive , Humans , SARS-CoV-2 , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/therapy
4.
J Parkinsons Dis ; 11(3): 971-992, 2021.
Article in English | MEDLINE | ID: covidwho-1201362

ABSTRACT

Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson's disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients' daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients' motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.


Subject(s)
Disorders of Excessive Somnolence , Parkinson Disease , REM Sleep Behavior Disorder , Restless Legs Syndrome , Sleep Apnea Syndromes , Sleep Disorders, Circadian Rhythm , COVID-19 , Disorders of Excessive Somnolence/diagnosis , Disorders of Excessive Somnolence/etiology , Disorders of Excessive Somnolence/therapy , Humans , Parkinson Disease/complications , Parkinson Disease/diagnosis , Parkinson Disease/therapy , REM Sleep Behavior Disorder/diagnosis , REM Sleep Behavior Disorder/etiology , REM Sleep Behavior Disorder/therapy , Restless Legs Syndrome/diagnosis , Restless Legs Syndrome/etiology , Restless Legs Syndrome/therapy , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/etiology , Sleep Apnea Syndromes/therapy , Sleep Disorders, Circadian Rhythm/diagnosis , Sleep Disorders, Circadian Rhythm/etiology , Sleep Disorders, Circadian Rhythm/therapy
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(4): 319-321, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-737643

ABSTRACT

The treatment of sleep disorders has been strongly impacted by the COVID-19 pandemic. When the lockdown is over, resumption of usual patient care will require precautions to limit the risk of contamination for patients and caregivers. In this document, the French Association of Otorhinolaryngology and Sleep disorders (AFSORL) and the French Society of Otorhinolaryngology (SFORL) put forward a summary of the measures for continuing the treatment of sleep apnoea syndrome in these new practice conditions. Emphasis is placed on teleconsultation, methods of nocturnal sleep studies, the conditions for treatment by continuous positive airway pressure (CPAP) ventilation, and the postponement of more invasive treatments.


Subject(s)
Continuous Positive Airway Pressure , Coronavirus Infections/epidemiology , Otolaryngology , Pneumonia, Viral/epidemiology , Sleep Apnea Syndromes/therapy , COVID-19 , Humans , Pandemics , Sleep Apnea Syndromes/diagnosis
6.
Respiration ; 99(8): 690-694, 2020.
Article in English | MEDLINE | ID: covidwho-733109

ABSTRACT

The attenuation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, at least in Italy, allows a gradual resumption of diagnostic and therapeutic activities for sleep respiratory disorders. The knowledge on this new disorder is growing fast, but our experience is still limited and when a physician cannot rely on evidence-based medicine, the experience of his peers can support the decision-making and operational process of reopening sleep laboratories. The aim of this paper is to focus on the safety of patients and operators accessing hospitals and the practice of diagnosing and treating sleep-related respiratory disorders. The whole process requires a careful plan, starting with a triage preceding the access to the facility, to minimize the risk of infection. Preparation of the medical record can be performed through standard questionnaires administered over the phone or by e-mail, including an assessment of the COVID-19 risk. The home sleep test should include single-patient sensors or easy-to-sanitize material. The use of nasal cannulas is discouraged in view of the risk of the virus colonizing the internal reading chamber, since no filter has been tested and certified to be used extensively for coronavirus due to its small size. The adaptation to positive airway pressure (PAP) treatment can also be performed mainly using telemedicine procedures. In the adaptation session, the mask should be new or correctly sanitized and the PAP device, without a humidifier, should be protected by an antibacterial/antiviral filter, then sanitized and reassigned after at least 4 days since SARS-CoV-2 was detected on some surfaces up to 72 h after. Identification of pressure should preferably be performed by telemedicine. The patient should be informed of the risk of spreading the disease in the family environment through droplets and how to reduce this risk. The follow-up phase can again be performed mainly by telemedicine both for problem solving and the collection of data. Public access to hospital should be minimized and granted to patients only. Constant monitoring of institutional communications will help in implementing the necessary recommendations.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Pandemics , Pneumonia, Viral , Polysomnography/methods , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/therapy , Telemedicine/methods , Air Filters , Betacoronavirus , COVID-19 , Clinical Decision-Making , Continuous Positive Airway Pressure/instrumentation , Disease Management , Disinfection , Evidence-Based Medicine , Humans , Italy , Polysomnography/instrumentation , Pulmonary Medicine , SARS-CoV-2 , Societies, Medical
8.
Sleep Med ; 74: 81-85, 2020 10.
Article in English | MEDLINE | ID: covidwho-654393

ABSTRACT

BACKGROUND: Due to the 2019 novel coronavirus (COVID-19) disease outbreak, social distancing measures were imposed to control the spread of the pandemic. However, isolation may affect negatively the psychological well-being and impair sleep quality. Our aim was to evaluate the sleep quality of respiratory patients during the COVID-19 pandemic lockdown. METHODS: All patients who underwent a telemedicine appointment from March 30 to April 30 of 2020 were asked to participate in the survey. Sleep difficulties were measured using Jenkins Sleep Scale. RESULTS: The study population consisted of 365 patients (mean age 63.9 years, 55.6% male, 50.1% with sleep-disordered breathing [SDB]). During the lockdown, 78.9% of participants were confined at home without working. Most patients (69.6%) reported at least one sleep difficulty and frequent awakenings was the most prevalent problem. Reporting at least one sleep difficulty was associated with home confinement without working, female gender and diagnosed or suspected SDB, after adjustment for cohabitation status and use of anxiolytics. Home confinement without working was associated with difficulties falling asleep and waking up too early in the morning. Older age was a protective factor for difficulties falling asleep, waking up too early and non-restorative sleep. Notably, SDB patients with good compliance to positive airway pressure therapy were less likely to report sleep difficulties. CONCLUSIONS: Home confinement without working, female gender and SDB may predict a higher risk of reporting sleep difficulties. Medical support during major disasters should be strengthened and potentially delivered through telemedicine, as this comprehensive approach could reduce psychological distress and improve sleep quality.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Pandemics , Pneumonia, Viral/psychology , Sleep Apnea Syndromes/psychology , Sleep Initiation and Maintenance Disorders/psychology , Social Isolation/psychology , Aged , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Portugal/epidemiology , SARS-CoV-2 , Sleep/physiology , Sleep Apnea Syndromes/epidemiology , Sleep Apnea Syndromes/therapy , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/therapy , Surveys and Questionnaires , Telemedicine/methods
9.
Sleep Med ; 73: 170-176, 2020 09.
Article in English | MEDLINE | ID: covidwho-654391

ABSTRACT

Since late December 2019, COVID-19, the disease caused by the novel coronavirus, SARS-CoV-2, has spread rapidly around the world, causing unprecedented changes in provided health care services. Patients diagnosed with sleep-disordered breathing (SDB) are subject to a higher risk of worse outcomes from COVID-19, due to the high prevalence of coexistent comorbidities. Additionally, treatment with positive airway treatment devices (PAP) can be challenging because of PAP-induced droplets and aerosol. In this context, sleep medicine practices are entering a new era and need to adapt rapidly to these circumstances, so as to provide the best care for patients with SDB. Novel approaches, such as telemedicine, may play an important role in the management of patients with SDB during the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Sleep Apnea Syndromes/therapy , Telemedicine/methods , COVID-19 , Continuous Positive Airway Pressure/methods , Continuous Positive Airway Pressure/trends , Coronavirus Infections/epidemiology , Equipment Contamination/prevention & control , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/epidemiology , Telemedicine/trends
10.
Sleep Med ; 74: 86-90, 2020 10.
Article in English | MEDLINE | ID: covidwho-653040

ABSTRACT

BACKGROUND: With the onset of the COVID-19 outbreak there has been concern that patients with obstructive sleep apnea (OSA) who develop COVID-19 may be at risk of greater morbidity and mortality than patients without OSA. COVID-19 is associated with an increased mortality in the elderly and particularly those with obesity, hypertension and diabetes, features which are typically seen in patients with OSA. This article describes the COVID-19 environment in New York City in which patients were evaluated and treated for OSA. METHODS: A telephone questionnaire survey of 112 OSA patients determined the occurrence of COVID-19 in the sleep apnea population and the patients' perspective on sleep apnea Positive Airway Pressure (PAP) management during the COVID-19 outbreak. The three main objectives of the survey were as follows: (1) To discover how patients were coping with COVID-19 pandemic in terms of their sleep apnea and PAP use, (2) To determine whether PAP usage changed after the onset of the outbreak in terms of adherence, and (3) To find out if patients were concerned about whether they were at greater risk of contracting COVID-19 because of their sleep apnea and, if they became infected, whether COVID-19 might result in greater complications because of the presence of sleep apnea. RESULTS/CONCLUSIONS: The adjustment in clinical management of OSA patients is described both during the peak of the outbreak in New York State (NYS), as well as the proposed modifications that will be instituted in order to return to full sleep center activities.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Disease Management , Pandemics/prevention & control , Pneumonia, Viral/therapy , Sleep Apnea Syndromes/therapy , Surveys and Questionnaires , Adult , Aged , Aged, 80 and over , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Sleep Apnea Syndromes/epidemiology , Telemedicine/methods , Telemedicine/trends , Young Adult
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