When we look at the data collected in New York, as well as other emerging COVID data around the globe, there is more evidence that sleep apnea is associated with worse COVID outcomes1. This makes inherent sense - we have long known that good sleep is important for our immune system2. We also recognize that untreated obstructive sleep apnea is linked to systemic inflammation3 - we are seeing this in our COVID patients as well.
PAP therapy may be somewhat protective as it supports both oxygenation and ventilation. It also allows for deeper, more restorative sleep which likely improves our immune system.
All of the news, though, is not favorable. There appears to be a very real risk of COVID spread from PAP devices via aerosolization4. It is imperative that we help our patients formulate a plan - can they self-isolate with their PAP devices5? Ideally, patients with COVID should be in their own sleep space. Some of our patients are unable to do this. If they share a sleep space with someone else, we need to have a discussion about the potential risk of SARS-CoV2 transmission via PAP therapy and assess whether we feel that it is safe to continue. PAP alternatives are discussed and deployed, depending upon the severity of the patient's sleep apnea and their treatment preference. Finances often play a significant role in this as well as many non-PAP treatments are not covered by insurance.
For these patients, positional therapy may be required.
Along with the risk of aerosolization, it is important to emphasize hand-washing prior to handling their PAP equipment. Masks and tubing should be cleaned regularly with soap and water and replaced after a respiratory illness.
Together, we can help our patients with sleep apnea stay safer by recognizing the potential risks and benefits of PAP therapy.
- McSharry D, Lam MT, Malhotra AT. OSA as a probable risk factor for severe COVID-19. J Clin Sleep Med. 2020;16(9):1649.
- Behaviorally Assessed Sleep and Susceptibility to the Common Cold Aric A. Prather, PhD, Denise Janicki-Deverts, PhD, Martica H. Hall, PhD, Sheldon Cohen, PhD Sleep, Volume 38, Issue 9, September 2015, Pages 1353-1359, https://doi.org/10.5665/sleep.4968
- Rev Endocr Metab Disord. 2015 Mar; 16(1): 25-34. doi: 10.1007/s11154-014-9304-x
- https://doi.org/10.3949/ccjm.87a.ccc003 PubMed 32371560 Published By Cleveland Clinic Journal of Medicine Print ISSN 0891-1150 Online ISSN 1939-2869