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Sleep laboratories reopening and COVID-19: a European perspective

Sophia Schiza, Anita Simonds, Winfried Randerath, Francesco Fanfulla, Dries Testelmans, Ludger Grote, Joseph M. Montserrat, Jean-Louis Pepin, Johan Verbraecken, Refika Ersu, Maria R. Bonsignore
European Respiratory Journal 2021 57: 2002722; DOI: 10.1183/13993003.02722-2020
Sophia Schiza
1Sleep Disorders Center, Dept of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
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Anita Simonds
2Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
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Winfried Randerath
3Institute of Pneumology at the University of Cologne, Bethanien Hospital, Solingen, Germany
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  • ORCID record for Winfried Randerath
Francesco Fanfulla
4Respiratory Function and Sleep Medicine Unit, IstitutiCliniciScientifici Maugeri IRCCS, Pavia, Italy
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Dries Testelmans
5Clinical Dept of Respiratory Diseases, UZ Leuven – BREATHE, Department CHROMETA, KU Leuven, Leuven, Belgium
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Ludger Grote
6Sleep Disorders Centre, Respiratory Medicine, Sahlgrenska University Hospital and Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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  • ORCID record for Ludger Grote
Joseph M. Montserrat
7Sleep Laboratory, Hospital Clinic, Universitat de Barcelona, Barcelona, and CIBER de Enfermedades Respiratorias, Madrid, Spain
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Jean-Louis Pepin
8HP2 laboratory, INSERM U1042, University Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France
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Johan Verbraecken
9Dept of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
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Refika Ersu
10Division of Pediatric Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
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Maria R. Bonsignore
11Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Dept, University of Palermo, and IRIB, National Research Council (CNR), Palermo, Italy
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  • For correspondence: marisa.bonsignore@irib.cnr.it
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  • FIGURE 1
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    FIGURE 1

    Flow chart summarising the screening procedures commonly adopted before access to the sleep laboratory or clinic. In phases of high coronavirus 2019 (COVID-19) transmission in the community, access to the sleep laboratory is limited to very urgent cases, and may require PCR testing.

  • FIGURE 2
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    FIGURE 2

    Flow chart summarising diagnostic procedures and precautions. In phases of high coronavirus 2019 (COVID-19) transmission in the community, PCR is usually required if in-laboratory polysomnography (PSG) is considered essential for diagnosis.

  • FIGURE 3
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    FIGURE 3

    Flow chart summarising positive airway pressure (PAP) titration procedures and precautions. In phases of high coronavirus 2019 (COVID-19) transmission in the community, in-laboratory titration is avoided, and may require PCR testing. PSG: polysomnography; NIV: noninvasive ventilation.

Tables

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  • TABLE 1

    Summary of recommendations for management of patients with sleep disordered breathing according to epidemiological situation

    VisitsSleep testEvaluation for COVID-19
    Stage 0: maximum transmission rateTelemedicine
    Phone
    No sleep studies, postpone initiation of treatment
    Home respiratory polygraphy in high-risk cases
    Clinical
    Stage 1: improvement of the pandemic situationTelemedicine
    Phone
    Home respiratory polygraphy (protection 1)
    CPAP in high-risk patients: automatic or telematic titration
    Clinical
    Stage 2: trend towards normalisation of the pandemicTelemedicine
    Phone
    In few cases: face to face
    Home respiratory polygraphy (protection 1)
    PSG (protection 2)
    CPAP: automatic or telematic titration (protection 1); demonstration in the laboratory (protection 2)
    PCR if PSG
    Protection 3 if titration in the laboratory

    COVID-19: coronavirus disease 2019; CPAP: continuous positive airway pressure; PSG: polysomnography. Protection 1: FFP2 mask, nitrile gloves, surgical gown (optional glasses or plastic shield); protection 2: PSG: the technician has to be comfortable while spending all the night with the patient; PCR is needed; FFP2 mask, surgical gown, hat, gloves and glasses (optional plastic face shield). Street clothes will not be used and the hospital uniform must be changed and cleaned daily; protection 3: FFP2/3 mask, nitrile gloves, surgical gown, hat, glasses/plastic face shields. Street clothes will never be used and the work uniform must be changed daily. It is recommended not to use open masks or circuits, but to use a closed circuit with an antiviral filter, turning on the equipment only when it is connected to the patient. Reproduced and modified from [5] with permission.

    Supplementary Materials

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      Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.

      Supplementary table E1 ERJ-02722-2020.Table_E1

      Supplementary table E2 ERJ-02722-2020.Table_E2

      Supplementary table E3 ERJ-02722-2020.Table_E3

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      Shareable PDF ERJ-02722-2020.Shareable

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    Sleep laboratories reopening and COVID-19: a European perspective
    Sophia Schiza, Anita Simonds, Winfried Randerath, Francesco Fanfulla, Dries Testelmans, Ludger Grote, Joseph M. Montserrat, Jean-Louis Pepin, Johan Verbraecken, Refika Ersu, Maria R. Bonsignore
    European Respiratory Journal Mar 2021, 57 (3) 2002722; DOI: 10.1183/13993003.02722-2020

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    Sleep laboratories reopening and COVID-19: a European perspective
    Sophia Schiza, Anita Simonds, Winfried Randerath, Francesco Fanfulla, Dries Testelmans, Ludger Grote, Joseph M. Montserrat, Jean-Louis Pepin, Johan Verbraecken, Refika Ersu, Maria R. Bonsignore
    European Respiratory Journal Mar 2021, 57 (3) 2002722; DOI: 10.1183/13993003.02722-2020
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