Snore Centre eNewsletter April 2020

No evidence OSA or CPAP use increases coronavirus risk

There is no current evidence that obstructive sleep apnoea (OSA) increases the risk for getting or developing complications of coronavirus (COVID-19). However, many patients with OSA may also have other long term health problems that may increase their risk. Please ensure that if you are affected by any other conditions that you check if they are relevant for COVID-19.

OSA Alliance advice for CPAP users:

• People with OSA should continue to use their CPAP at home as normal.
• There is no evidence that using CPAP makes you more likely to catch COVID-19, and nothing to suggest that CPAP will make you more unwell if you do catch it.
• If a CPAP user becomes unwell with symptoms suggestive of COVID-19 (new cough and fever > 37.8 C), please follow government guidance regarding self and household isolation.
• We do not know whether CPAP makes virus spread worse within a household. This will be something you will need to consider when deciding whether or not to continue using CPAP if you are self-isolating with symptoms of COVID-19. You may wish to distance yourself from vulnerable household members by changing bedrooms or stopping CPAP for a short time.
• Any respiratory infection, particularly with a blocked nose, can make it more difficult to use CPAP. Try and persist, but if wearing CPAP makes you feel worse (e.g. by increasing coughing and disturbing sleep), then stop using it until your respiratory symptoms improve. Sleeping more upright, avoiding alcohol and using a mandibular advancement spilt if you have one, may help as alternatives to CPAP in reducing OSA a little in this period. Your OSA symptoms are likely to worsen over the week, but will resolve when you restart CPAP.
• Routine hygiene is adequate for infection control: changing machine filters routinely, cleaning surfaces, cleaning mask and tubing with hand-hot soapy water (washing up liquid) and washing hands regularly.
• Masks and machines should not be shared.
• Please use the telephone number/email address provided by your sleep centre for urgent issues with your equipment or sleep/OSA related symptoms. Do not attend in person unless instructed to do so. Please be aware the team may not be able to respond quickly, as staff may have been moved to Emergency Services.
• Please look after masks and tubing carefully as there may be a temporary shortage in the future.
• A reminder that DVLA says anyone with excessive sleepiness having or likely to have an adverse effect on driving must not drive.

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The hospital in Italy where no staff have contracted COVID-19

In northern Italy thousands of medical staff are getting sick fighting the coronavirus pandemic and dozens have died - but far to the south, they have had time to prepare. Sky News reports on a hospital where the staff are protected from infection.

At Cotugno Hospital, a specialist infectious diseases facility that now only treats COVID-19 patients, armed guards patrol the corridors. As we walked inside we passed disinfection machines that look like airport scanners, but they clean you down.

While the speed of the virus storm caught everyone by surprise in the north, and medical teams were overwhelmed, things at this hospital were different. We were taken, fully clothed in our protective layers and goggles, into one of their Intensive Care Units (ICU).

This was a whole different level to anything we have seen before. The staff treating the sickest patients are wearing super advanced masks - much nearer to a gas mask than we normally see our hospital staff wearing. They are clad in thick waterproof suits that means the doctors and nurses are effectively sealed in.

Incredibly, so far at least, not a single member of the medical teams has been affected - it seems it can be done, you just have to have the right gear and follow the right protocols. We sensed a sudden change. A nurse rushed past us desperately drawing medicine in to a syringe. A patient inside one of the treatment rooms is deteriorating fast.

As we watched on, he prepared an injection outside the treatment room. He never goes inside but communicated through a window to colleagues with the patient. They never come outside during crisis moments, and this is one.

When it's ready, the medicine is passed through a compartment door. Remember, he's not been inside and hasn't touched anyone or anything - but he immediately removes his gloves and scrubs down. This attention to detail is an absolute constant.

This hospital is the exception in the south of the country. It was already the most advanced, but we began to realise that keeping the medical teams safe is possible. What they're noticing is that everyone and anyone can get infected, not just the old.

There are many young patients being treated here and interestingly they are finding that the middle classes are being infected the most. I asked why? The answer is obvious really - they travel.

What is really striking here is that the rules of separating infected environments and the clean areas are followed by everyone. But armed security guards are on every connecting corridor in case anyone forgets.

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BBC reports people with OSA waiting up to two years for treatment

People with obstructive sleep apnoea (OSA) are having to wait up to two years for appropriate treatment accourding to a BBC report this month

Paul Wilson, 72, from Essex, went to see his GP in April 2018 when he first began to experience chronic drowsiness. It took nine months before he was given an appointment at his local hospital and then a further three months before he was able to see a sleep specialist.

"I was told I would be referred and was given the choice of five clinics, even though none of them had appointments available," Mr Wilson told BBC News.

"I then chased, after a few months, to no success and it wasn't until the following year that I was finally contacted about an appointment to see a specialist."

Test results showed Mr Wilson was stopping breathing about 56 times every hour while asleep and he was given a continuous positive airway pressure (CPAP) mask to wear while sleeping, which significantly improved his quality of life immediately.

"I was not aware how much it was impacting me and I had no idea how dangerous it was," he said. "It came as quite a shock. I'm not falling asleep during the day any more, I'm sleeping through the night and so is my wife now my snoring has improved."

Respiratory consultant Dr Annabel Nickol, who leads the sleep and ventilation service in Oxford, said patients with "disabling symptoms" were being left to struggle alone because services were at capacity across the country.

"There is a crisis facing sleep services in the UK," she said.

"During prolonged waiting periods, patients are exposed to ongoing burdensome symptoms and the sixfold increased risk of having a road traffic accident due to loss of concentration or 'micro-sleeps' behind the wheel.

"If patients are advised to discontinue driving until they receive effective treatment, they may have significant loss of independence or even loss of employment."

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Sharp rise in children being admitted to hospital with sleep disorders

The Guardian reports that thousands of children and teenagers in England are being admitted to hospital for sleep disorders, with admissions for conditions such as insomnia almost doubling in seven years.

Experts have described the situation as a hidden public health problem, putting it down to rising obesity levels, excessive use of social media before bedtime and a mental health crisis engulfing young people.

The Guardian analysed data from NHS Digital, the national information and technology partner to the health and social care system in England, which revealed that hospital admissions for under-16s with a primary diagnosis of sleep disorder rose from 6,549 in 2012-13 to 9,451 in 2017-18 and 11,313 in 2018-19.

By comparison, sleep disorder admissions for all ages rose only slightly between 2012-13 and 2018-19, from 29,511 to 30,098.

Vicki Dawson, the founder of the NHS Doncaster-funded Children’s Sleep Charity, the only free specialist service that provides support to families for children’s sleep, said the organisation had been inundated with requests from families seeking help.

“We find it hard to meet the demand due to our very limited resources,” she said. “The rise will be linked to a number of factors, firstly, sleep-disordered breathing issues in children which is linked to obesity. It is commonly recognised that there is a problem around childhood obesity in the UK. What isn’t recognised is that poor sleep quality can be a driver for it, impacting on the release of hormones that manage appetite and hunger.”

Dawson said another area where they were seeing a significant rise was in children’s mental health issues “and again there is a strong link between anxiety and sleep deprivation. Unfortunately sleep is not on the public health agenda despite the huge impact it has on all areas of wellbeing, and when it goes wrong there aren’t specialist services for families to access.”

Dawson also noted that screen activity played a role, saying there was “a real lack of understanding around the impact that screens can have on sleep”. Some research suggests the light from screens can suppress the sleep hormone melatonin, she said.

The NHS data is for sleep conditions that were severe enough to warrant admission to hospital. This meant they were under the care of the hospital, as opposed to being an outpatient visiting for an appointment, and were usually given a bed, even if they didn’t end up staying overnight.

Most of the admissions were for sleep apnoea, a serious disorder that occurs when breathing is interrupted at night. Numbers for young people’s admissions reached 7,557 in 2016-17, up from 5,675 in 2012-13.

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BBC Stories: Are you holding your breath in your sleep?