VERY IMPORTANT COVID-19 GUIDANCE
Guidance regarding coronavirus (COVID-19) and Obstructive Sleep Apnoea (OSA):
for people who routinely use continuous positive airway pressure (CPAP), their families and health care workers, 20th March 2020
Complied by Dr Sonya Craig and Dr Sophie West with the OSA Alliance (incorporating British Thoracic Society, British Sleep Society, Association for Respiratory Technology and Physiology, Sleep Apnoea Trust Association).
Patients with OSA should follow the government advice re COVID-19: https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response.
There is no data yet regarding the risk of OSA alone in terms of COVID-19 susceptibility.
- People with OSA should continue to use their CPAP at home as normal.
- There is no evidence that using CPAP makes you more likely to catch COVID-19, and nothing to suggest that CPAP will make you more unwell if you do catch it.
- If a CPAP user becomes unwell with symptoms suggestive of COVID-19 (new cough and fever > 37.8 C), please follow government guidance regarding self and household isolation.
- We do not know whether CPAP makes virus spread worse within a household. This will be something you will need to consider when deciding whether or not to continue using CPAP if you are self-isolating with symptoms of COVID-19. You may wish to distance yourself from vulnerable household members by changing bedrooms or stopping CPAP for a short time.
- Any respiratory infection, particularly with a blocked nose, can make it more difficult to use CPAP. Try and persist, but if wearing CPAP makes you feel worse (e.g. by increasing coughing and disturbing sleep), then stop using it until your respiratory symptoms improve. Sleeping more upright, avoiding alcohol and using a mandibular advancement spilt if you have one, may help as alternatives to CPAP in reducing OSA a little in this period. Your OSA symptoms are likely to worsen over the week, but will resolve when you restart CPAP.
- Routine hygiene is adequate for infection control: changing machine filters routinely, cleaning surfaces, cleaning mask and tubing with hand-hot soapy water (washing up liquid) and washing hands regularly.
- Masks and machines should not be shared.
- Please use the telephone number/email address provided by your sleep centre for urgent issues with your equipment or sleep/OSA related symptoms. Do not attend in person unless instructed to do so. Please be aware the team may not be able to respond quickly, as staff may have been moved to Emergency Services.
- Please look after masks and tubing carefully as there may be a temporary shortage in the future.
- A reminder that DVLA says anyone with excessive sleepiness having or likely to have an adverse effect on driving must not drive.
Sleep out-patient advice for hospitals
- Routine out-patient visits should be avoided unless urgent.
- Remote monitoring and telephone consultations may be an option for some.
- Posting of masks and equipment from Sleep centres should be encouraged, without patients attending.
Advice for a person with OSA who routinely uses CPAP who is unwell and admitted to hospital due to suspected/confirmed COVID-19
- Bring your CPAP machine into hospital with you.
DO NOT USE YOUR CPAP UNLESS INSTRUCTED BY STAFF: you may be asked not to use CPAP for OSA on an open ward if you have suspected COVID-19, until COVID-19 screening results are back. If you use CPAP for Obesity Hypoventilation Syndrome (OSA, obesity plus respiratory failure) requiring CPAP to maintain ventilation, this should be continued but will need an isolation area (such as side room or negative pressure area), so please be guided by medical staff caring for you.
- To decrease any risks of infection from CPAP whilst you are in hospital: your usual mask, which has a vent to allow you to breathe out, may be changed. The new temporary mask will not have this vent, but a bacterial/viral filter can also be added along with an exhalation port in the tubing.
- DO NOT USE your humidifier with your CPAP machine in hospital due to increased droplet spread.
For a copy of this information please click here OSA Alliance CPAP COVID 19 advice 20 3 20
For advice on how to sanitise, clean and maintain your CPAP equipment, please refer to the “Living With Your CPAP” leaflet or the equivalent A4 Patient Information Sheet (for home printing), by clicking the links below:
VERY IMPORTANT DVLA GUIDANCE
If, after a sleep test, you diagnose a patient with mild, moderate or severe OSA and NO EXCESSIVE SLEEPINESS then do NOT advise them to contact the DVLA.
If, after a sleep test, you diagnose a patient with moderate or severe OSA WITH EXCESSIVE SLEEPINESS then advise them to contact the DVLA.
If, after a sleep test, you diagnose a patient with mild OSA WITH EXCESSIVE SLEEPINESS which is still present after 3 months,then advise them to contact the DVLA.
The DVLA has no rules concerning compliance other than:
control of condition
The DVLA will need medical confirmation of the above and the driver must confirm review to be undertaken every three years the minimum for Group 1 car and motorcycle and annually for Group 2 bus and lorry.
There are no rules from the DVLA concerning level of AHI or hours on CPAP, only that medically the patient is clinically assessed to meet the above three conditions.
The British Thoracic Society (BTS) have published a revised Position Statement on Driving and Obstructive Sleep Apnoea (OSA) 2018. All Clinical Staff should follow the advice provided by the BTS in this Position Statement, in conjunction with the revised DVLA Guidance published in March 2019 “Assessing fitness to drive – a guide for medical professionals March 2019”
The recent problems with DVLA seem to be stabilising. But for the time being SATA continues to advise that you do not advise patients who drive and you suspect to have sleep apnoea and have not been diagnosed through consultation and sleep test with an appropriate Sleep Clinic, to telephone, email or use the online medical reporting system to contact the DVLA, but to write and keep a copy. A mistake can easily lead to an unecessarily revoked licence
The much clearer explanation of the new rules published by the DVLA and updated in March 2019 and read in conjunction with the BTS Position Statement will lead to a much better understanding by patients and clinicians of their position as regards informing the DVLA.
We have been informed that you are now being frequently asked about flying and CPAP. SATA has up to date information on all the airlines flying from the UK, with a simple traffic light guide as follows:
Airlines in Green – allow CPAP used on seat power where available, otherwise batteries
Airlines in Yellow – specify battery use at all times (even when power is available)
Airlines in Red – No CPAP usage allowed, or no positive information on website
We also include the latest version of the General Medical Councils Guidance on Patient Confidentiality, both to inform patients and keep clinicians updated.
SATA was instrumental in lobbying for the provision of treatment for Sleep Apnoea resulting in its recommendation by NICE (National Institute for Health and Care Excellence)
Please make your selection below:
Assessing Fitness to Drive – A Guide for Medical Professionals – March 2019
NICE (National Institute for Health & Care Excellence)