The Australasian Sleep Association is calling a halt to non-essential face to face CPAP or NIV set ups and diagnostic and CPAP sleep studies, due to the risk of COVID-19 transmission.

The advice comes in a Consensus statement on the safe use of respiratory therapy and sleep studies to minimise aerosolisation of CoVID-19 released on 6 April.

Among the many points in the statement, the ASA advises that all patients requiring respiratory therapy should be assumed to have potential CoVID-19 “and be mindful that there is up to a 30% false negative rate for the viral swab.”

It states that as nebulisers, high flow oxygen and NIV (including CPAP)  all pose a risk of COVID-19 transmission and should only be used in patients that really need them. Also, the tests should be used in isolation/single rooms and with appropriate PPE.

“Non-essential face to face CPAP or NIV set ups should now cease to limit the potential community spread of COVID-19 and for staff safety,” it advises.

The ASA notes that particle dispersion is highest using nasal pillows at higher pressures (e.g. 20 cmH2O) and may be the lowest with a well-fitting oronasal mask. It is possible to send equipment to patients and instruct them via telehealth or via phone.

Similarly, it recommends non-essential diagnostic and CPAP sleep studies and diagnostic home sleep studies with face to face set up should cease to reduce the risk of community spread of COVID-19 and for staff safety.

Other highlights of the statement include advice that nebulisation and humidification is not necessary for most patients and this therapy should be replaced by MDI and spacer.

For oxygen therapy, the lowest flow rate of oxygen should be used to maintain oxygen saturations to minimise risk of viral aerosolisation. “High flow oxygen therapy via nasal prongs (HFNP) is unnecessary for many patients and this therapy should be replaced by O2 via standard nasal prongs/cannula, Hudson mask, or non-rebreather mask,” the ASA advises.

For acute use of NIV including CPAP, clinicians should assume that all patients have potential COVID-19 (including those with COPD/OHS etc), and therefore use double-limb non-vented masks with an expiratory filter in the circuit and PPE until swabs are negative

Long term users in the home environment should be aware that aerosolisation of upper airway secretions may assist viral spread via the exhalation port of the mask.

“Users of these therapies who are or are potentially infected with COVID-19 should be aware of this possibility and should not use CPAP or bilevel NIV around others,” the ASA states.

Patients with suspected or proven COVID-19 should be advised to consider discontinuation of CPAP therapy until recovered, but Bilevel NIV users in the home environment therapy should continue unless advised by the treating respiratory or sleep physician.

“This is a work in progress in a primarily evidence free zone and will continue to be updated as the pandemic evolves,” the ASA states.

“We have much to learn from each other during this crisis and we must work together to minimise risk to ourselves and thus help our patients.”