Free AccessLetters to the EditorRationale for reverse-transcription polymerase chain reaction for SARS-CoV-2 screening in patients undergoing in-laboratory sleep studies Leonardo Serra, MD Leonardo Serra, MD Address correspondence to: Leonardo Serra, MD, Centro del Sueño, Clínica Alemana de Santiago, Vitacura 5951, 7650568 Vitacura, Santiago, Chile; Email: E-mail Address: [email protected] Search for more papers by this author Published Online:June 1, 2021https://doi.org/10.5664/jcsm.9232SectionsAbstractPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTCitation:Serra L. Rationale for reverse-transcription polymerase chain reaction for SARS-CoV-2 screening in patients undergoing in-laboratory sleep studies. J Clin Sleep Med. 2021;17(6):1333.INTRODUCTIONAs with most sleep laboratories around the globe, we had to stop our sleep testing activities the last days of March 2020 because of the COVID-19 pandemic, and before being able to resume it, we had to create new protocols to ensure the safety of patients and staff. Currently, there are some guidelines available,1–3 but when we decided to restart (late June 2020), there was less evidence than is available today. Our protocol consists of screening surveys on scheduling of the sleep test and at the day of the visit (including respiratory symptoms, fever, diarrhea, fatigue, muscle pain, headache, changes in smell or taste, close contacts, and traveling) and reverse-transcription polymerase chain reaction of nasopharyngeal swab 48 hours before admission. Between June and December 31, 2020, we performed a total of 376 polysomnography tests, finding 2 positive reverse-transcription polymerase chain reactions in the asymptomatic patient screening (0.5%); both cases became mildly symptomatic a few days later, and in the first case, the whole family became infected soon after.Reverse-transcription polymerase chain reaction is the recommended test for investigation of asymptomatic individuals,4 and at least one-third of SARS-CoV-2–infected individuals are asymptomatic, with 75% of those who test positive without symptoms remaining asymptomatic.5 Up to 50% of confirmed cases may be actively infected in the absence of symptoms (asymptomatic or presymptomatic period, which may account for 44% of secondary transmission).6 In our country, patients diagnosed without symptoms have ranged between 8.2% and 63.3% of confirmed cases.7 Universal screening for women admitted for delivery was done in New York and found 13.5% of patients were positive for COVID-19 infection, and 88% were asymptomatic.8 We found an unexpected high rate of asymptomatic patients in a period of low stable prevalence (80 active cases/100,000 inhabitants)7 when screening for in-laboratory polysomnography. Reverse-transcription polymerase chain reaction may not be feasible everywhere, but where available, we think there is justification to include it in patient screening for elective procedures.DISCLOSURE STATEMENTThe author has seen and approved the manuscript. The author reports no conflicts of interest.REFERENCES1. American Academy of Sleep Medicine. Update from the AASM COVID-19 Task Force, January 2021. Covid-19 Testing. https://aasm.org/update-covid-19-task-force-january-2021/. Accessed on February 14, 2021. Google Scholar2. Gupta R, Kumar VM, Tripathi M, et al.. Guidelines of the Indian Society for Sleep Research (ISSR) for practice of sleep medicine during COVID-19. Sleep Vigil. 2020;4(2):61–72. https://doi.org/10.1007/s41782-020-00097-2 CrossrefGoogle Scholar3. Pirzada A, Awadh AA, Aleissi SA, Almeneessier AS, BaHammam AS. Reopening sleep medicine services in the conundrum of an ongoing COVID-19 pandemic: a global view. Sleep Vigil. 2020;4(2):73–80. https://doi.org/10.1007/s41782-020-00100-w CrossrefGoogle Scholar4. Arevalo-Rodriguez I, Seron P, Buitrago-García D, et al.. Recommendations for SARS-CoV-2/COVID-19 testing: a scoping review of current guidance. BMJ Open. 2021;11(1):e043004. https://doi.org/10.1136/bmjopen-2020-043004 CrossrefGoogle Scholar5. Oran DP, Topol EJ. The proportion of SARS-CoV-2 infections that are asymptomatic: a systematic review [published online ahead of print, 2021 Jan 22]. Ann Intern Med. 10.7326/M20-6976. Google Scholar6. Trubin PA, Azar MM, Malinis M. Diagnostic testing of COVID-19 in solid organ transplantation: current clinical application and future strategies. Curr Transplant Rep. 2020;7(4):1–9. https://doi.org/10.1007/s40472-020-00307-w Google Scholar7. Government of Chile. COVID-19 in Chile: Official Data. https://www.gob.cl/coronavirus/cifrasoficiales/. Accessed on February 14, 2021. Google Scholar8. Sutton D, Fuchs K, D’Alton M, Goffman D. Universal screening for SARS-CoV-2 in women admitted for delivery. N Engl J Med. 2020;382(22):2163–2164. https://doi.org/10.1056/NEJMc2009316 CrossrefGoogle Scholar Previous article FiguresReferencesRelatedDetails Volume 17 • Issue 6 • June 1, 2021ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationFebruary 14, 2021Submitted in final revised formMarch 1, 2021Accepted for publicationMarch 1, 2021Published onlineJune 1, 2021 Information© 2021 American Academy of Sleep MedicinePDF download