The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in the shutdown of obstructive sleep apnea (OSA) management throughout the world. Based on data aimed at containing the spread of the virus, different approaches were proposed in Europe and the United States for the reopening of sleep laboratories.1 The extensively summarized procedures and precautions are not so “friendly” in guiding health workers in managing OSA objective testing and positive airway pressure (PAP) titration in the usual daily activities during the SARS-CoV-2 era. The Italian OSA SARS-CoV-2 Working Group (Ita-OSA-SARS-CoV-2-WG), as mandatory government guidelines and local health care facilities were adopted to minimize the spread of viral infection, established recommendations to ensure workplace safety and establish safety measures for patients and for health workers. The Ita-OSA-SARS-CoV-2-WG, in agreement with the clinical practice guideline of the American Academy of Sleep Medicine2,3 and scientific national recommendations,1 stated that objective testing and treatment of OSA must be carried out, even during the SARS-CoV-2 pandemic. Indeed, OSA must be treated to protect these patients from the risk of cardiovascular and cerebrovascular complications, perioperative complications, and/or occupational or road accidents.3 Furthermore, the treatment of OSA appears to be associated with a better prognosis if SARS-CoV-2 infection occurs.4 The working group also stated that the diagnosis of OSA must be carried out with devices that allow the direct measurement of the oronasal airflow and that the practice of telemedicine should be preferred. The Ita-OSA-SARS-CoV-2-WG also proposed a friendly “Traffic Light OSA-SARS” table (Table 1) as a tool for the management of OSA, especially for sleep laboratories who only care for outpatients. The procedures for OSA objective testing and PAP titration in the current pandemic era used by home care providers have been considered. Utilizing a color scale, as in traffic lights, the “Traffic Light OSA-SARS” provides a guideline for OSA management during the SARS-CoV-2 pandemic, including recommended actions and procedures (green color), alternative actions or procedures (yellow color), and not suitable actions or procedures (red color). The “Traffic Light OSA-SARS” is also used for the management of non-OSA sleep breathing disorders. The sleep laboratories at which the members of the Ita-OSA-SARS-CoV-2-WG are employed are located throughout the Italian territory.
Table 1.
The “Traffic Light OSA-SARS” summarizes actions and procedures for OSA objective testing and PAP titration during the SARS-CoV-2 pandemic.
| Recommended (Green) | Alternative (Yellow) | Not Suitable (Red) | |
|---|---|---|---|
| Outpatient visit | Telephone screening for SARS-CoV-2 infection before visit† | Screening for SARS-CoV-2 infection the day of the access | Perform visit if SARS-CoV-2 infection is suspected or diagnosed |
| Body temperature measurement | Body temperature measurement | ||
| PSG/HST | Nasopharyngeal swab before testing with†: | If nasopharyngeal swab testing not performed: | |
| • HST | • HST at home* | ||
| • PSG in a dedicated single room of the laboratory in complicated OSA | • PSG in a dedicated single room of the laboratory in complicated OSA* | Perform test if SARS-CoV-2 infection is suspected or diagnosed | |
| Airflow measurement with both: | Airflow measurement with both: | ||
| • disposable nasal cannulas | • disposable nasal cannulas | ||
| • disposable thermistor | • thermistor‡ | ||
| Disposable pulse oximeter sensor | Pulse oximeter sensor‡ | ||
| Disposable thoraco-abdominal band | Thoraco-abdominal band‡ | ||
| Disposable electrodes | Electrodes‡ | ||
| Snoring detection with microphone | Snoring detection with disposable nasal cannula | ||
| PAP titration | Nasopharyngeal swab before titration†: | If nasopharyngeal swab testing not performed, titration: | |
| • at home using telemonitoring | • at home using telemonitoring§ | ||
| • in a dedicated single room of the laboratory in complicated OSA | • in a dedicated single room of the laboratory in complicated OSA§ | Perform titration if SARS-CoV-2 infection is suspected or diagnosed | |
| Disposable calibers for the interface choice | Calibers for the interface choice‡ | Use the humidifier | |
| Disposable circuits and masks | Circuits and masks‡ | ||
| Disposable filter within the circuit | Disposable filter within the circuit | ||
| Do not use the humidifier | Do not use the humidifier |
†Preferably 24 hours before the objective testing or PAP titration; however, not earlier than 48 hours prior to the procedures. *Seventy-two hours quarantine device before the objective testing. ‡After sanitization according to local adopted health care facilities. §Seventy-two hours quarantine PAP device before the titration. HST = home sleep testing, OSA = obstructive sleep apnea, PAP = positive airway pressure, PSG = polysomnography, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.
DISCLOSURE STATEMENT
All authors have seen and approved the manuscript. The authors report no conflicts of interest.
ACKNOWLEDGMENTS
Italian OSA SARS-CoV-2 Working Group: Antonino Attinà, MD; Crotone, Italy; Elvia Giovanna Battaglia, MD; Milano, Italy; Salvatore Bellofiore, MD; Catania, Italy; Elisabetta Bertocco, MD; Vicenza, Italy; Serafina Bevilacqua, MD; Catanzaro, Italy; Marcello Bosi, MD; Forlì (FC), Italy; Matteo Bradicich, MD; Zurich, Switzerland; Isa Cerveri, MD; Pavia, Italy; Claudio Ciacco, MD; Orbassano (TO), Italy; Angelo Corsico, MD; Pavia, Italy; Pietro Crudele, MD; Salerno, Italy; Ilaria D'Amico, MD; Livorno, Italy; Domenico D’Intino, MD; Chieti, Italy; Loreta Di Michele, MD; Roma, Italy; Alessandro Fois, MD; Sassari, Italy; Antonio Foresi, MD; Sesto San Giovanni (MI), Italy; Emiliano Gatti, MD; Orbassano (TO), Italy; Agostino Greco, MD; Fano (PU), Italy; Donato Lacedonia, MD; Foggia, Italy; Nicola Launora, MD; Saluzzo (CN), Italy; Marco Mantero, MD; Milano, Italy; Luigi Marino, MD; Vittorio Veneto (TV), Italy; Andrea Melani, MD; Siena, Italy; Manlio Milanese, MD; Savona, Italy; Giorgio Emanuele Polistina, MD; Napoli, Italy; Biagio Polla, MD; Alessandria, Italy; Salvatore Privitera, MD; Giarre (CT), Italy; Piera Ranieri, MD; Brescia, Italy; Antonina Re, MD; Ancona, Italy; Antonio Sanna, MD; Empoli (FI), Italy; Pietro Schino, MD; Acquaviva delle Fonti (BA), Italy; Mario Schisano, MD; Siracusa, Italy; Matteo Schisano, MD; Catania, Italy; Matteo Siciliano, MD; Roma, Italy; Lucia Spicuzza, MD; Catania, Italy; Domenico Maurizio Toraldo, MD; San Cesario di Lecce (LE), Italy; Roberto Torchio, MD; Torino, Italy; Emmanuele Tupputi, MD; Trani (BT), Italy; Anna Rita Tusino, MD; San Severo (FG), Italy
Sanna A, Foresi A, Siciliano M, Torchio R. The “Traffic Light OSA-SARS”: a tool for the management of obstructive sleep apnea in the pandemic era. J Clin Sleep Med. 2021;17(11):2337–2338.
Contributor Information
on behalf of the OSA SARS-CoV-2 Working Group—Italian Respiratory Society (SIP/IRS):
Antonino Attinà, Elvia Giovanna Battaglia, Salvatore Bellofiore, Elisabetta Bertocco, Serafina Bevilacqua, Marcello Bosi, Matteo Bradicich, Isa Cerveri, Claudio Ciacco, Angelo Corsico, Pietro Crudele, Ilaria D'Amico, Domenico D’Intino, Loreta Di Michele, Alessandro Fois, Antonio Foresi, Emiliano Gatti, Agostino Greco, Donato Lacedonia, Nicola Launora, Marco Mantero, Luigi Marino, Andrea Melani, Manlio Milanese, Giorgio Emanuele Polistina, Biagio Polla, Salvatore Privitera, Piera Ranieri, Antonina Re, Antonio Sanna, Pietro Schino, Mario Schisano, Matteo Schisano, Matteo Siciliano, Lucia Spicuzza, Domenico Maurizio Toraldo, Roberto Torchio, Emmanuele Tupputi, and Anna Rita Tusino
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