To the Editor:
A consequence of the 2019 novel coronavirus (Covid-19) pandemic has been the extreme difficulty responding to non-Covid19-related health needs [1]; additionally, the reopening of sleep laboratories presents further difficulties. The possibility of cross-infection and the risk of spreading the virus using the same device limits access to diagnosis, thus increasing already overwhelmed waiting lists [2]. Although there have been several suggestions, currently no definitive guidelines have solved this issue [3]. During this health emergency, we managed the reopening of a sleep lab proposing a home-made circuit to permit safe home sleep apnea testing (HSAT).
We created a specific home-made circuit where the nasal cannula was connected to an antiviral filter, which reached the HSAT device through a breathing hose connector (Figure E1). The circuit was tested in subsequent patients over one week. Moreover, volunteers performed in the same night a HSAT with standard nasal-cannula (STCAN) and an HSAT with the filtered nasal-cannula (FCAN), to avoid night to night variability.
Data of 20 patients (age 61.5 ± 18.9yrs; 18 males) referred because of suspected obstructive sleep apnea were analyzed. The overall apnea hypopnea index (AHI) median [25°-75°interquartile range] was 11.3 [5.4–19.7] according to SUM and 19.1 [7.5–31.3] according to FCAN (p = 0.002). SUM underestimated the Apnea Index (4.3 [1.9–9.0]) in comparison to FCAN (9.3 [3.2–16.0]; p = 0.001) (Figure E2).
After comparing the AHI of FCAN and STCAN among the three volunteers, we found no difference in AHI (p = 1) (Figure E3).
Clinicians struggled with the needs of diagnostic sleep tests' recovery and avoiding cross-patient infections. Some specialists decided to perform HSAT analyzing the SUM signal, losing important diagnostic information while others used HSAT devices a three-day cycle according to Covid-19's survive time [3,4], drastically reducing the number of effective tests.
Our proposed circuit permits those undergoing HSAT to have a valid nasal flow signal, avoiding the risk of cross-contamination, representing a temporary bridge until diagnostic procedures return to the pre-COVID high-quality standard.
Acknowledgements
We would like to acknowledge stimulating discussions and practical help of our sleep-technicians, especially Francesca Gregorini, Barbara Riccardi, Irene Risi e Elena Robbi. We would like to sincerely thanks all the essential workers for their invaluable role during this pandemic crisis.
Footnotes
None declared.
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: https://doi.org/10.1016/j.sleep.2020.08.015.
Supplementary data to this article can be found online at https://doi.org/10.1016/j.sleep.2020.08.015.
Conflict of interest
The following is the supplementary data to this article:
Appendix A. Supplementary data
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