Positive Airway Pressure Therapy and COVID-19: What Patients Need to Know

All forms of positive airway pressure (PAP) therapy should be assumed to increase the risk of droplet and aerosolized transmission of COVID-19.

So advises a practical review of PAP therapy and COVID-19 transmission published by Cleveland Clinic sleep disorders specialist Colleen G. Lance, MD, in a collection of COVID-19 Curbside Consults from Cleveland Clinic Journal of Medicine.

Noting that PAP therapy is an open system that can generate contact, droplet and airborne pathogens, Dr. Lance outlines evidence supporting implementation of contact, droplet and airborne precautions for patients on PAP therapy in the context of the COVID-19 pandemic.

Dr. Lance helpfully summarizes recommendations on PAP therapy and COVID-19 from the American Academy of Sleep Medicine (AASM) relating to two broad patient scenarios:

• PAP use at home among asymptomatic individuals. Highlights include advice that the PAP therapy user should sleep in a separate bedroom and, if possible, use a separate bathroom.
• PAP use among individuals with suspected or confirmed COVID-19. The key guidance here is that discontinuation of PAP therapy for a short period may be reasonable until the patient is no longer contagious. In cases of temporary discontinuation, interim measures for reducing sleep apnea should be considered, including positional therapy during sleep, use of a dental appliance (if the patient has one), treatment of nasal congestion, and avoiding alcohol and sedating medications.

The review also distills recommendations from an AASM guidance on sleep clinic and sleep laboratory activities during substantial community spread of COVID-19. Central advice here is that in-laboratory sleep studies should be postponed for all patients and home sleep apnea testing should be postponed unless disposable testing devices are used exclusively.

Dr. Lance shares that current practice of Cleveland Clinic’s Sleep Disorders Center is to evaluate potentially urgent requests for in-lab sleep studies on a case-by-case basis. Additionally, Cleveland Clinic uses disposable devices for home sleep apnea testing and disinfects all nondisposable components.

The review concludes with an overview of evidence on emergency use of PAP equipment as a substitute for ventilation, noting that basic continuous PAP and bilevel PAP devices are not designed to function as ventilators and that additional PAP devices, including those with noninvasive ventilation capacity, are not substitutes for ventilators in the context of acute respiratory failure.

Dr. Lance’s referenced review article from Cleveland Clinic Journal of Medicine’s COVID-19 Curbside Consults is available here.