Main Article Content
obstructive sleep apnea syndrome, Covid-19, inflammation, non-invasive ventilation, CPAP
Obstructive sleep apnea (OSA) is a broadly diffused curable chronic low-grade inflammatory disease sharing impressive clinical and pathogenetic features with Covid-19. Moreover, a potential role of OSA as a detrimental factor for Covid-19 severity has been hypothesized. Continuous positive airway pressure (CPAP) is the mainstay treatment for moderate-severe OSA, but the beneficial effects of ventilation strongly depend on medical expertise and on the patient’s adherence and compliance. Although several papers have analyzed the overlaps and outcomes of OSA and Covid-19, limited attention has been dedicated to ventilatory adherence and management of OSA cohorts exposed to Covid-19. We briefly review the literature data, pointing out the main risks and benefits of CPAP for OSA patients in the pandemic setting.
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. New Engl J Med. 2020.
Beumer MC, Koch RM, van Beuningen D, et al. Influenza virus and factors that are associated with ICU admission, pulmonary co-infections and ICU mortality. J Crit Care. 2019;50:59‐65
Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes 2013;37:333– 340.
Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020 Aug 1;116(10):1666-1687.
Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. 2020;323(16):1612–1614. doi:10.1001/jama.2020.4326
Maas, M.B., Kim, M., Malkani, R.G. et al. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure. Sleep Breath (2020). https://doi.org/10.1007/s11325-020-02203-0
Cariou, B., Hadjadj, S., Wargny, M. et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia 63, 1500–1515 (2020). https://doi.org/10.1007/s00125-020-05180-x
Cross MD, Mills NL, Al-Abri M, et al. Continuous positive airway pressure improves vascular function in obstructive sleep apnoea/ hypopnoea syndrome: a randomized controlled trial. Thorax. 2008; 63: 578–83.
Lindner KH, Lotz P, Ahnefeld FW. Continuous positive airway pressure effect on functional residual capacity, vital capacity and its subdivisions. Chest 1987;92(1):66-70.
Ning Y, Zhang TS, Wen WW, et al.. Effects of continuous positive airway pressure on cardiovascular biomarkers in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. Sleep Breath. 2019 Mar;23(1):77-86.
Perrini S, Cignarelli A, Quaranta VN, et al. Correction of intermittent hypoxia reduces inflammation in obese subjects with obstructive sleep apnea. JCI Insight. 2017 Sep 7;2(17):e94379.
Lau HL, Rundek T, Ramos AR. Sleep and Stroke: New Updates on Epidemiology, Pathophysiology, Assessment, and Treatment. Curr Sleep Med Rep. 2019 Jun;5(2):71-82
Sawyer AM, Goonerathne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med. Rev., 2011, 15: 343-356
Drummond M. Sleep labs, lung function tests and COVID-19 pandemic - Only emergencies allowed! Pulmonology. 2020 Jul-Aug;26(4):244-245..
Barker J, Oyefeso O, Koeckerling D, Mudalige NL, Pan D. COVID-19: community CPAP and NIV should be stopped unless medically necessary to support life. Thorax. 2020 May;75(5):367.
Thorpy M, Figuera-Losada M, Ahmed I, et al. Management of sleep apnea in New York City during the COVID-19 pandemic. Sleep Med. 2020;74:86-90. doi:10.1016/j.sleep.2020.07.013.
Baker JG, Sovani M. Case for continuing community NIV and CPAP during the COVID-19 epidemic. Thorax. 2020 May;75(5):368. doi: 10.1136/thoraxjnl-2020-214913. Epub 2020 Apr 9. PMID: 32273336.
Nakano H, Kadowaki M, Furukawa T, Yoshida M. Rise in nocturnal respiratory rate during CPAP may be an early sign of COVID-19 in patients with obstructive sleep apnea. J Clin Sleep Med. 2020 Jul 28:jc-20-00338. Epub ahead of print. PMID: 32720641.
Voulgaris A, Ferini-Strambi L, Steiropoulos P. Sleep medicine and COVID-19. Has a new era begun? Sleep Med. 2020 Sep;73:170-176.