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Bouloukaki I, Pataka A, Mauroudi E, Moniaki V, Fanaridis M, Schiza SE. Impact of the COVID-19 pandemic on positive airway pressure adherence and patients' perspectives in Greece: the role of telemedicine. J Clin Sleep Med 2023; 19:1743-1751. [PMID: 37218340 PMCID: PMC10545996 DOI: 10.5664/jcsm.10664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023]
Abstract
STUDY OBJECTIVES To analyze the impact of national lockdowns in Greece on positive airway pressure adherence, patients' perspectives regarding COVID-19 pandemic and the role of telemedicine. METHODS 872 obstructive sleep apnea patients from southern and 673 from northern Greece, under positive airway pressure 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 positive airway pressure adherence and patients' concerns regarding COVID-19 infection. RESULTS Significant difference was noted in positive airway pressure 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 = .003) and northern Greece (5.3 vs 6.0, P = .03). The proportion of patients with optimal adherence (≥ 6 hours) increased by 18% (P = .004) in southern and by 9% (P = .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 obstructive sleep apnea diagnosis, while only 3% reported decreased sleep duration. Moreover, 9% were concerned that the presence of obstructive sleep apnea 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. CITATION Bouloukaki I, Pataka A, Mauroudi E, Moniaki V, Fanaridis M, Schiza SE. Impact of the COVID-19 pandemic on positive airway pressure adherence and patients' perspectives in Greece: the role of telemedicine. J Clin Sleep Med. 2023;19(10):1743-1751.
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Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athanasia Pataka
- Department of Respiratory Medicine, G Papanikolaou Hospital, Respiratory Failure Unit, Aristotle University of Thessaloniki, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Michalis Fanaridis
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E. Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
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Abstract
The COVID-19 pandemic affected sleep in several people. Though most of the studies argued that age, gender, employment, finances, responsibilities, and exposure to sunlight governed sleep-wake schedule and sleep disturbances, there is also scientific evidence to suggest that these issues could have aroused because of the infiltration of the central nervous system (CNS) by SARS-CoV-2. Sleep disturbances must be addressed during the pandemic as sleep disturbances and systemic inflammation run in a vicious cycle; quality of sleep and timing of vaccination can influence the immune response to vaccination and subjects having obstructive sleep apnea (OSA) are at higher risk for having SARS-CoV-2 infection-related complications.
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Affiliation(s)
- Niraj Kumar
- Department of Neurology, Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Ravi Gupta
- Department of Psychiatry, Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India.
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Kim SW, Kim HH, Kim KY, Lee SH, Kang HH. Impacts of the COVID-19 pandemic on sleep center operations and sleep apnea treatment in Korea: A multicenter survey. Medicine (Baltimore) 2021; 100:e28461. [PMID: 34941202 PMCID: PMC10545019 DOI: 10.1097/md.0000000000028461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The coronavirus disease-2019 (COVID-19) pandemic has not only changed the lives of people around the world but also affected all areas of the healthcare system, including sleep medicine. However, no studies in Korea have investigated the status of domestic sleep centers and their challenges during the pandemic.An online survey was performed from December 2020 to January 2021. Hospitals that belonged to sleep-related academic societies and were considered well managed were included in this survey. The questionnaire focused on changes in sleep center operations, infection control policies, and patient treatment since the start of the COVID-19 pandemic. Telemedicine and future directions for sleep medicine services were also investigated.Of the 20 sleep centers that responded, 80% were at university hospitals with more than 500 inpatient beds. During the third wave of the COVID-19 pandemic in Korea (November-December 2020), the routine operating schedule of the sleep study room was reduced in 30% of the sleep centers compared to November-December 2019 (before COVID-19). The number of type 1 polysomnographies performed decreased in 85% of the sleep centers. In contrast, in-lab positive airway pressure (PAP) titrations decreased in 40%, remained unchanged in 35%, and increased in 25%. With respect to prescriptions, 30% of the sleep centers increased the number of prescriptions for auto-titrating continuous PAP. However, 60% of the sleep centers reported no change in the rate of fixed continuous PAP and auto-titrating continuous PAP prescriptions. All sleep centers that participated in this survey agreed that the need for documented infection control regulations will continue after the COVID-19 pandemic. Since the beginning of the pandemic, 30% of the centers have tried telemedicine. However, respondents expressed concern about telemedicine, citing a number of practical issues.Compared to countries where the COVID-19 pandemic was severe, Korea had less impact of COVID-19 on the sleep center operations and sleep apnea treatment. Infection and quality control in the sleep study room are important and inevitable issues, and regulation within each institution is necessary. Further research and discussion are needed regarding telemedicine and home sleep apnea test in Korea.
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Affiliation(s)
- Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwan Hee Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyu Yean Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Hui Kang
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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Pataka A, Kotoulas S, Sakka E, Katsaounou P, Pappa S. Sleep Dysfunction in COVID-19 Patients: Prevalence, Risk Factors, Mechanisms, and Management. J Pers Med 2021; 11:1203. [PMID: 34834555 PMCID: PMC8618512 DOI: 10.3390/jpm11111203] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
During the COVID-19 pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress, identify predisposing and protective factors, and explore effective management strategies remains an important priority. Evidence to date suggests that a considerable proportion of COVID-19 patients experience significant sleep disturbances (estimated to afflict up to 50-75%) as well as psychological distress such as depression, anxiety, and traumatic stress. Duration of hospitalization, pre-existing mental health concerns, lower absolute lymphocyte count, and increased neutrophil-to-lymphocyte ratio have been all associated with a greater risk of sleep dysfunction in infected and hospitalized patients. Furthermore, in this review, we discuss the link between sleep deprivation, susceptibility to viral infections, and psychosocial wellbeing in relevance to COVID-19 and summarize the existing evidence regarding the presence and role of sleep apnea in infected individuals. Finally, we highlight the importance of suitable interventions in order to prevent and manage sleep dysfunction and avoid long-term physical and psychological implications. Future research should aim to provide high-quality information including in high risk, underserved, or difficult to reach populations and on the long-term consequences and effectiveness of applied interventions.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Seraphim Kotoulas
- Respiratory Failure Unit, G Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Elpitha Sakka
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton BN2 4AT, UK;
| | - Paraskevi Katsaounou
- Department of Respiratory Medicine, First ICU, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Sofia Pappa
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK; or
- West London NHS Trust, London UB2 4SD, UK
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A Fully Remote Diagnostic and Treatment Pathway in Patients with Obstructive Sleep Apnoea during the COVID-19 Pandemic: A Single Centre Experience. J Clin Med 2021; 10:jcm10194310. [PMID: 34640326 PMCID: PMC8509359 DOI: 10.3390/jcm10194310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic led to significant delays in the diagnostic and management pathway of patients with obstructive sleep apnoea (OSA). During the first wave of COVID-19, our department adopted a fully remote diagnostic (home cardiorespiratory polygraphy) and treatment (autoset continuous positive airway pressure, CPAP) approach. As a novel mode of service delivery, our aim was to evaluate our pathway and analyse factors associated with adherence to CPAP. We analysed the first 300 patients (51 ± 13 years, 48% men) who were set up on remote CPAP between 20 May 2020 and 11 September 2020. The associations between CPAP usage at 90 days and age, gender, body mass index, disease severity, Epworth Sleepiness Scale and comorbidities were investigated with linear and logistic regression analyses. A total of 124 patients (41.3%) were fully-adherent to CPAP therapy, defined as CPAP usage ≥ 4 h on ≥ 70% of the days. Only driving status was associated with adherence to CPAP. Patients who were adherent at 28 days were more likely to stay adherent at 90 days (3.77 odd ratio /3.10-4.45/ 95% confidence interval). We have shown that a fully remote diagnostic and treatment pathway for patients with OSA can be successfully delivered, and our preliminary outcomes of adherence to CPAP are comparable with published data.
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Tiotiu A, Chong Neto H, Bikov A, Kowal K, Steiropoulos P, Labor M, Cherrez-Ojeda I, Badellino H, Emelyanov A, Garcia R, Guidos G. Impact of the COVID-19 pandemic on the management of chronic noninfectious respiratory diseases. Expert Rev Respir Med 2021; 15:1035-1048. [PMID: 34253132 DOI: 10.1080/17476348.2021.1951707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: The COVID-19 pandemic has challenged health care across the world, not just by the severity of the disease and the high mortality rate but also by the consequences on the management of the patients with chronic diseases.Areas covered: This review summarizes the most up-to-date published data regarding the impact of COVID-19 on the management and outcomes of patients with chronic noninfectious respiratory illnesses including obstructive sleep apnea, asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial and pulmonary vascular diseases, and lung cancer.Expert opinion: Most of chronic respiratory diseases (except asthma and cystic fibrosis) are associated with more severe COVID-19 and poor outcomes but the mechanisms involved are not yet identified. The therapeutic management of the patients with chronic respiratory diseases and COVID-19 is similar to the other patients but the post-recovery course could be worse in this population and followed by the development of pulmonary fibrosis, bronchiectasis, and pulmonary hypertension. The pandemic highly impacted our usual medical activities by limiting the access to several diagnosis procedures, the necessity to develop new methods for the monitoring of the disease and adapt the therapeutic strategies. The long-term consequences of all these changes are still unknown.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Herberto Chong Neto
- Division of Allergy, Immunology and Pulmonology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Andras Bikov
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, United Kingdom; Andras
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24a, Bialystok, Poland.,Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, Alexandroupolis, Greece
| | - Marina Labor
- Department of Pulmonology, Värnamo Hospital, Värnamo, Sweden
| | - Ivan Cherrez-Ojeda
- Department of Allergy, Immunology & Pulmonary Medicine, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University Named after I.I.Mechnikov, Saint-Petesrburg, Russian Federation
| | - Rocio Garcia
- Department of Pneumology. Universitary Hospital « 12 De Octubre », Madrid, Spain
| | - Guillermo Guidos
- Department of Inmmunology, SEPI-ENMH, Instituto Politecnico Nacional, Mexico City
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Grote L, Theorell-Haglöw J, Ulander M, Hedner J. Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services-Longitudinal Data from the Swedish Sleep Apnea Registry. Sleep Med Clin 2021; 16:409-416. [PMID: 34325820 PMCID: PMC8258548 DOI: 10.1016/j.jsmc.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.
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Affiliation(s)
- Ludger Grote
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, 40530 Gothenburg, Sweden; Respiratory Department, Sleep Disorders Center, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden.
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset ing 40, 75185 Uppsala, Sweden; Respiratory Department, The Sleep Apnea Center, Uppsala University Hospital, 75185 Uppsala, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, 58185 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, 58185 Linköping, Sweden
| | - Jan Hedner
- Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 8B, Box 421, 40530 Gothenburg, Sweden; Respiratory Department, Sleep Disorders Center, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Spicuzza L, Sanna A. Continuum of care for patients with obstructive sleep apnea after one year from the COVID-19 pandemic onset: no time for further delays: practical issues for a safe and effective management. Sleep Med 2021; 84:98-106. [PMID: 34144451 PMCID: PMC8166158 DOI: 10.1016/j.sleep.2021.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
Since the SARS-CoV-2 pandemic onset, many routine medical activities have been put on hold and this has deeply affected the management of patients with chronic diseases such as obstructive sleep apnea. Untreated OSA is associated with increased mortality and difficulties in social functioning. A delay in initiating treatment may therefore have harmful consequences. Between February and April 2020, the so-called first wave of the pandemic, the overall activity of sleep centers in Europe was reduced by 80%. As the international infection control authorities released guidelines for SARS-CoV-2 outbreak control, many of the national sleep societies provided strategies for a gradual re-opening of sleep facilities. Most of these strategies were not evidences-based and, in a climate of general concern, worldwide it was strongly advised to post-pone any non-urgent sleep-related procedure. Despite the initial idea that the outbreak could be transient, after one year it is still ongoing and the price we are paying, not only includes deaths caused by COVID-19, but also deaths caused by missed or late diagnosis. As further delays in diagnosing and treating patients with sleep apnea are no more acceptable, a new arrangement of sleep facilities and resources, in order to operate safely and effectively, is now mandatory. In this article, we review most recent literature and guidelines in order to provide practical advice for a new arrangement of sleep laboratories and the care of patients with obstructive sleep apnea after one year from the onset of the COVID-19 pandemic.
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Affiliation(s)
- Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Antonio Sanna
- Azienda USL Toscana Centro - Pneumology and Bronchial Endoscopy Unit, San Giuseppe Hospital, Empoli, FI, Italy
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Schiza S, Simonds A, Randerath W, Fanfulla F, Testelmans D, Grote L, Montserrat JM, Pepin JL, Verbraecken J, Ersu R, Bonsignore MR. Sleep laboratories reopening and COVID-19: a European perspective. Eur Respir J 2021; 57:13993003.02722-2020. [PMID: 33214202 PMCID: PMC7683791 DOI: 10.1183/13993003.02722-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/03/2020] [Indexed: 01/05/2023]
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. Specific precautions should be applied for starting activities in respiratory sleep centres during the COVID-19 epidemichttps://bit.ly/3keRjii
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Affiliation(s)
- Sophia Schiza
- Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Anita Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Winfried Randerath
- Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IstitutiCliniciScientifici Maugeri IRCCS, Pavia, Italy
| | - Dries Testelmans
- Clinical Dept of Respiratory Diseases, UZ Leuven - BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Ludger Grote
- Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital and Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Joseph M Montserrat
- Sleep Laboratory, Hospital Clinic, Universitat de Barcelona, Barcelona, and CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Jean-Louis Pepin
- HP2 laboratory, INSERM U1042, University Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Verbraecken
- Dept of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Refika Ersu
- Division of Pediatric Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Maria R Bonsignore
- Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Dept, University of Palermo, and IRIB, National Research Council (CNR), Palermo, Italy
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