Changes in Positive Airway Pressure Application and Practices in Individuals with Sleep-Related Breathing Disorder During the COVID-19 Pandemic

Abstract

The positive airway pressure (PAP) therapy prescription and use for individuals with sleep-related breathing disorder (SRBD) have been affected by the COVID-19 pandemic, given concerns for aerosolizing risk associated with PAP therapy use. Guidelines have recommended balancing the risks and benefits of continuing PAP therapy during the pandemic by assessing cohabitation status, severity of underlying SRBD, comorbidities, and occupation safety. At the same time, untreated SRBD has been shown to be associated with poor outcomes in patients contracting COVID-19 infection. Although PAP prescriptions have decreased during the pandemic and PAP initiation methods have shifted from face-to-face to remote setups, PAP use has not changed and potentially increased since the beginning of the COVID-19 pandemic. It has been found that individuals with the lowest PAP use before the pandemic demonstrated the most marked improvement in PAP use. Male gender and age 65 years and older were associated with increased PAP use compared to their female and younger counterparts. Conversely, higher stress levels, depression, poor sleep quality, remote PAP setup, and living with someone who experienced symptoms that could be attributable to COVID-19 have been suggested to be associated with lower PAP use. Critically, lower PAP usage was found in individuals newly started on PAP after the first wave of the pandemic. Further research is needed to identify populations at risk of reducing PAP use and target education strategies.