Category: <span>Newsletter</span>

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Letters from Dr Bentley: June 2020

Dear Colleague

What strange times we are living in. I hope this newsletter finds you well. When the COVID pandemic hit I was quite sure that obstructive sleep apnea had no place in the discussions. I may have been wrong. Please find some interesting information about the relationship between OSA and COVID infection.

1. What do I do about using my CPAP machine during the pandemic?

Keep using it but be aware of the increased aerolisization caused by CPAP which is more severe than that from coughing or sneezing and it goes on all night. So there is an increased risk of cross infection if you are COVID positive and using a CPAP machine. Thus extra hygiene and cleaning measures may be required.

2. Should I rather not use my CPAP machine then?

That is not a good option. Quite apart from the obvious increase in cardiovascular morbidity that comes with untreated OSA, OSA may be another risk factor for increased severity of COVID. In a sample of diabetic patients with severe COVID illness, treated obstructive sleep apnea (OR 2.80 [1.46, 5.38]) was independently associated with an increased risk of death on day 7 – reason unclear (Cariou et al 2020). It is also unclear whether untreated OSA carries an increased risk of death from COVID infection. Patients with the highest mortality risk of COVID – men, over 50 years old, with hypertension, obesity and diabetes, sound very much like the classical patient with OSA. They already score 4 factors on the STOP-BANG questionnaire (a score of 5 or more would be 80% predictive of OSA) (Nagappa et al PLoS One 2015).

3. Why would OSA increase the risk for mortality in severe COVID infection?

Severe COVID infection is characterised by a cytokine storm and systemic inflammation. Patients with OSA, particularly if they also have metabolic dysfunction, have a higher level of pro-inflammatory cytokines as well as increased endothelial dysfunction and systemic inflammation (Bonsignore et al Eur Respir Rev 2013). The prevalence of OSA in patients with factors linked to an increased severity of COVID disease – hypertension and diabetes – ranges from 30-60% – higher than the proposed 10-20% national prevalence of OSA (Benjafield et al Lancet Respir Med. 2019).

Thus there is an urgency for all patients with OSA to be diagnosed and treated. Diagnostic studies and CPAP titrations are done at home therefore not increasing the exposure risk to COVID in hospitals or excess person contact. Screening of possible patients with possible OSA using the STOP-BANG questionnaire is recommended.I hope this information is useful in your daily practice.

Sincerely

Dr Alison Bentley – Sleep Clinician

cpap treatment

Letters from Dr Bentley: The Impact of Nasal CPAP Treatment

Welcome all to 2020 and I hope this year goes well for you. This is our first newsletter for the year where I try and give some new information on obstructive sleep apnea which I hope will help you in your management of these patients.

Here is a summary of a recent meta-analysis of the impact of CPAP treatment on various symptoms and comorbid disorders. It is an official review by the American Academy of Sleep Medicine and the full reference is listed at the bottom of the page in case you would like to find it and study it in more detail.

Read more

sleep apnoea

Letters from Dr Bentley: Interesting Information about Obstructive Sleep Apnea

Dear Colleague

Welcome to our short newsletter which gives you some (hopefully) interesting information about obstructive sleep apnea.

It can be quite challenging to decide which patients to screen for obstructive sleep apnea (OSA) as the perceived prevalence is quite low. This is incorrect – the prevalence in the adult population ranges between 10 and 24% increasing to 49% in people over 65 years. Read more

IS OBSTRUCTIVE SLEEP APNEA (OSA) A SIGNIFICANT CONFOUNDER IN THE DIAGNOSIS AND MANAGEMENT OF PSYCHIATRIC DISORDERS IN ADULTS?

Obstructive sleep apnea is a disorder of sleep related breathing which has increased in prevalence as the epidemic of obesity …

cpap treatment

Letters from Dr Bentley: June 2020

Dear Colleague What strange times we are living in. I hope this newsletter finds you well. When the COVID pandemic hit I …

middle aged man sleeping

Avoid Doctor Waiting Rooms and Hospitals By Improving Sleep

Although all doctors have put in strict measures at their practices to avoid patients with suspected COVID-19 from sitting …