If a patient is suspected or confirmed to have COVID-19, we suggest assessing the risks and benefits of continuing to use a PAP (CPAP/BPAP) device at home.
WHAT ARE THE RISKS OF CONTINUING PAP THERAPY?
- There may be an increased risk of transmission of COVID-19 to others in the environment if PAP is continued.
- Consider individuals residing in proximity to the patient, especially if they are at risk for severe infection. Dispersion of the virus with PAP is theoretically greater with than without PAP, but how much the risk to others changes specifically because of PAP therapy is not known.
- Viral particles may persist for some time depending on the type of surface.
- Persons at risk for infection from using PAP include co-habitants of the same dwelling.
- Additionally, whether it is possible for the patient to be re-infected from tubing, filters, and/or mask reuse is not known.
WHAT ARE THE RISKS OF DISCONTINUING PAP THERAPY?
- OSA is a chronic disorder, and the risk of stopping PAP for a limited period of time until the patient is no longer contagious may be manageable, depending on the severity of the disorder and symptoms. Without PAP, however, some patients may experience an increase in health risks in the short term, such as accidents, safety incidents, falls, or cardiovascular events.
- If such acute risks are identified, risk-mitigation strategies may be appropriate, such as advising the patient to stop driving, adhere to fall precautions, and consult with their treating physician to optimize medical management of background medical conditions.
- Using positional therapy or an oral appliance (if the patient already has one), limiting the use of alcohol and sedating medications, and addressing nasal congestion may also be effective for some patients.
- If these short-term risk mitigation strategies are insufficient, and a decision is made to continue PAP in a patient who has confirmed COVID-19, or is suspected of having COVID-19, the patient should be advised to maintain strict quarantine and consider strategies for protecting household contacts.
The decision of whether to continue or stop PAP therapy should be based on whether the risk: benefit assessment favors continued therapy.