key: cord-1032824-1dmy3cdh authors: Sullivan, Colin E. title: Snoring and obstructive sleep apnoea as risk factors in SARS-Cov-2: can nasal CPAP during sleep reduce pneumonia risk? date: 2020-11-07 journal: Sleep Biol Rhythms DOI: 10.1007/s41105-020-00295-5 sha: 024c14ef1b78f0560d144218b46ea78a01d34094 doc_id: 1032824 cord_uid: 1dmy3cdh nan viral infection in the nasopharynx and the onset of the lung disease, unrecognised snoring and sleep apnoea may be significant mechanisms increasing aspiration during sleep and exposing the lungs to high levels of viral inoculates. Rather than waiting for the patient to develop lung changes, early use of nasal CPAP in sleep might offer a safe method of helping to reduce the progression to potentially fatal COVID 19 pneumonia. The report by Oranger et al. [8] supports this idea, as CPAP was used continuously only during the night, and thus during presumed sleep. The problem of viral spread can be minimized with the use of appropriate circuit filters [8, 9, 10] , good mask fit [11, 2] including the use of adapted surgical masks over a nasal CPAP interface [13, 14] , and usual barrier nursing. Given that mask CPAP is being used to help slow the progress of the worsening pneumonia once respiratory failure has developed, introducing it earlier to the sleeping patient with COVID 19 does not require a major change in clinical protocols. Conflict of interest C E Sullivan was inventor of nasal CPAP for treating sleep apnoea (Lancet, 1981) and was a founder of ResMed (1989) a manufacturer of CPAP but has had no ongoing relationship since 2003. CES family have minor shareholdings in ResMed. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area Comorbidity Burden of Obstructive Sleep Apnea in a Large Academic Health Center (222) Sleep Apnea and COVID-19 mortality and hospitalization Association between obstructive sleep apnea and community-acquired pneumonia SARS-CoV-2 Reverse genetics reveals a variable infection gradient in the respiratory tract COVID-19: community CPAP and NIV should be stopped unless medically necessary to support life Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia Continuous positive airway pressure to avoid intubation in SARS-CoV-2 pneumonia: a two-period retrospective case-control study Delivering oxygen-enriched CPAP respiratory support using a non-invasive ventilation device. medRxiv Home PAP devices in COVID-19 infected patients The importance of mask selection on continuous positive airway pressure outcomes for obstructive sleep Apnea. An official American thoracic society workshop report Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion Use of high-flow nasal cannula and noninvasive ventilation in patients with COVID-19: a multicenter observational study