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Hospital cuts COVID-19 death rates using sleep apnoea "black boxes" - No evidence OSA or CPAP use increases coronavirus risk- Lockdown resulting in more sleep for some... - Try the Snore Centre Mobile App - Michael Oko explains cardiac anatomy
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Snore Centre eNewsletter May 2020

Hospital cuts COVID-19 death rates using sleep apnoea "black boxes".


Sky News reported on 25th April on medics fighting COVID-19 in a hospital in Cheshire who seem to have cut mortality rates and improved the chances of a quick recovery from the virus by adapting breathing machines normally used for a sleeping disorder. 

Doctors at Warrington Hospital have modified devices known as "black boxes" which usually treat sleep apnoea - a condition which means breathing stops and starts while sleeping.

The clinicians say by treating COVID-19 patients early with their "black boxes", it has meant there has been less need for the more intrusive and invasive ventilators and they've experienced a far quicker recovery rate. One of the hospital's consultants said they had started from "ground zero" in how to manage the pandemic in the area.

Dr Mark Forrest told Sky News: "We watched very closely what was happening in other countries, in particular Italy, and learned from them."

At the same time, they realised using ventilators - which require a breathing pipe to be inserted down the throat and the patient to be put under anaesthetic - had a relatively poor recovery rate. In some cases it was only 50-50.

This realisation was in line with medics across the world who were also finding it was a long and difficult journey to bring COVID-19 patients back to recovery from ventilation - and a journey which often didn't result in survival.

The team made an early decision to try to avoid ventilation by switching to CPAP machines (continuous positive airway pressure) where the device pumps oxygen, under a constant pressure, into the lungs through a close-fitted face mask.

The device keeps the airways continuously open in those patients who are able to breathe on their own but it stops their lungs from collapsing. But again, like many hospitals across the country and the world, the hospital only had a limited number in stock. In Warrington's case, they had six.

They'd heard of reports that engineering teams from Mercedes Formula One and doctors at University College London Hospital were attempting to upgrade existing CPAP devices to meet the need for COVID-19 patients.

"But this seemed months away and we needed the machines now," said Dr Forrest. A spokesman for UCL said around 10,000 machines have been manufactured and are already being distributed to NHS hospitals. NHS healthcare professionals can request the devices for their hospitals at no cost.

The boxes, which are considerably cheaper than the hospital versions, are simple enough for patients to use at home at night for typically a maximum of 12 hours. But the medics in the hospital's intensive care unit (ICU) found by putting patients on the black boxes as soon as they arrived in the department, they stabilised quickly, avoiding ventilation.

The respiratory team at the hospital, working in close collaboration with their ICU colleagues, modified the boxes by fitting them with superior masks and linking them up to oxygen.

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No evidence OSA or CPAP use increases coronavirus risk

There is no current evidence that obstructive sleep apnoea (OSA) increases the risk for getting or developing complications of coronavirus (COVID-19). However, many patients with OSA may also have other long term health problems that may increase their risk. Please ensure that if you are affected by any other conditions that you check if they are relevant for COVID-19.

OSA Alliance advice for CPAP users:

  • 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.

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Lockdown resulting in more sleep for some, but less for others suffering stress


 

The coronavirus pandemic may be something of a living nightmare for many – but more British people have been sleeping better than ever.

A new study has found that three in five people, or 62%, are getting just as much shut-eye, if not more, than before the lockdown began in the UK on March 23rd. Researchers at King’s College London – who surveyed more than 2,300 people in collaboration with polling company Ipsos Mori – have discovered that school closures and working from home have inadvertently helped increasing numbers get a good night’s kip.

However, on the flip-side, the economic impact of the outbreak has meant just over a third of participants have been kept up at night by financial worries. According to Professor Bobby Duffy, director of the Policy Institute at King’s College, this group are experiencing less, and more restless, sleep. Further research, conducted by scientists at Oxford University, has shown that teenagers have been getting up later, with one in three eleven to 16-year-olds indulging in generous lie-ins.

Russell Foster, a professor and director of the Sleep and Circadian Neuroscience Institute at Oxford told The Sunday Times that most workers in the UK “do not get enough sleep in our busy 24/7 society, which means most of us are usually sleep-deprived. It is interesting that may now be being reversed.”

It comes as it was revealed that the position you fall asleep in could actually end up causing you health problems, ranging from aches and pains to sleep apnoea.

Oliver Elliot, expert at Nectar Sleep, explained: “Everyone sleeps differently but if you subconsciously fall into the incorrect sleeping position, neck, back and other muscle problems may become exacerbated.”

He continued: “It’s important to recognise your body’s needs and try to adapt your physical positioning when trying to drift off to sleep, being mindful of tension in your body.”

For example, ‘the log roller’ can ease pack and neck pain, and involves resting on your side with legs extended straight and arms by your side. You can also treat yourself to a set of black-out blinds from Amazon costing £20 that will ward off light pollution if you live in an urban area.

They have received almost 4,500 reviews on the site, with many shoppers crediting them with transforming their sleep patterns – as well as those of their families.

One relieved parent commented: “I bought this for my toddlers’ bedroom; I didn’t want to make holes in the walls of my apartment hanging curtain rods and liked the idea that this sticks directly to the glass, leaving very little space for the light to leak through.

“We also travel/sleep away from home often and thought it would be helpful to be able to take it with me. It went up easily and blocked out the light nearly completely.”

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BBC Stories: Are you holding your breath in your sleep?




Watch the video on the BBC
 
 

Have You Tried Our Mobile App?

 

 
Keep up with all the latest news and research on sleep apnoea from the Sleeping Disorders Centre with this nifty free app. Here you can find all our social media channels (YouTube/Facebook/Twitter/Blog) all in one place, right on your phone.

Be sure to let us know what you think of our app by leaving a review on iTunes or the Google Play Store. All your feedback is valuable to us.

 

Download the app for Android devices

Download the app for iOS devices


Michael Oko explains cardiac anatomy using virtual reality  ​


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