OSA, COVID, and CPAP Recall
Breathing is mandatory to sustain life and we often take it for granted until we start having trouble breathing. The novel coronavirus SARS-CoV-2 is a highly transmissible virus that causes respiratory illness in humans that can lead to death. It emerged in late 2019 and has caused a pandemic of acute respiratory disease, named ‘coronavirus disease 2019’ (COVID-19). Obstructive Sleep Apnea (OSA) involves compromised breathing during sleep and is most often managed with Positive Airway Pressure (PAP) and uses pressurized air to maintain airway patency during sleep. PAP has been considered the “First Line” therapy for OSA since it was first introduced in the early 1980s. Dentistry has used an alternative to PAP for the management of OSA, with an Oral Appliance (OA), which maintains airway patency during sleep by holding the jaw in a forward position. Studies demonstrate that only 30-40% of patients wear their PAP all night, versus approximately 90% for Oral Appliances (OA). Measurements of therapeutic benefit are similar for both devices, believed to be due to this much higher compliance rate.
Patients on CPAP Devices Should be Prescribed an Oral Appliance (OA) to Patients Who Snore or Have Been Diagnosed with OSA or COVID-19.
PAP has been implicated with spreading COVID-19 within the Washington state nursing home in February 2020 which became ground zero in North America during this Pandemic. The First Responders that responded to the Life Care nursing facility in Kirkland Seattle in late February used nebulizers and PAP machines to treat patients. “It’s best practice for us for people with respiratory illnesses,” said Jim Whitney, medical services administrator for the Redmond Fire Department. “We had no idea that we potentially had COVID patients there… We essentially aerosolized it,” said one responder after the fact, “We made it worse”. It was only later that King County public health officials advised Redmond Fire and other first responders in the region not to use PAP for patients suspected of having COVID-19 illness. Whitney said responders were using machines with specialized filters, which can reduce the amount of virus released. But King County public health authorities recommend that first responders avoid using PAP altogether. Redmond Fire has now discontinued the use of PAP for COVID-19 patients.
An Oral Appliance (OA) can Easily be Disinfected to Kill COVID-19 Viruses by Patients and Does Not Share Any of the Aerosol Liabilities Associated with PAP Devices
The American Academy of Sleep Medicine currently recommends that if a PAP user becomes positive for COVID-19, they should speak to their physician about assessing the risks and benefits of continuing to use the PAP device at home. Persons at risk for infection from continued PAP usage include all cohabitants of the same household. In these cases, an Oral Appliance (OA) could be considered an effective alternative to PAP. For these reasons, on November 3, 2020, an official position statement by the American Academy of Dental Sleep Medicine (AADSM) stated the following: Oral Appliance Therapy Should be Prescribed as a First-Line Therapy for OSA during the COVID-19 Pandemic (the official AADSM statement is listed below).
More Contagious Variants of COVID-19 will Continue to Emerge, and Simpler Alternatives Like Oral Appliances (OA) Should be First-Line Therapy
On June 2021, Phillips's Respironics recalled millions of CPAPS, Bilevel PAPs, and Ventilators which sent shock waves throughout sleep medicine and has resulted in sleep lab administrators and sleep clinicians searching for alternative sleep apnea therapies for their patients. Even the very best fitting PAP devices leak, this is simply a limitation of the technology and acknowledged as acceptable by ResMed, the inventor of PAP. Now that we know about the liability associated with PAP, we should never forget it - prescribe only oral appliances.
Credit to John Viviano can be reached at John@DrViviano.com, Office: 905 212 7732, Cell: 416 500 2901