Is it true that a CPAP machine that treats sleep apnea helps with pneumonia and respiratory distress caused by coronavirus?

Is it true that a CPAP machine that treats sleep apnea helps with pneumonia and respiratory distress caused by coronavirus?

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answers (2)

Answer 1
January, 2021

"CPAP" is the russified name of the English-language abbreviation CPAP ( Constant Positive Airway Pressure) - constant positive airway pressure. This describes the basic principle of operation of the CPAP machine or ventilator mode commonly used in intensive care units.

A modern ventilator is a high-tech system for delivering a gas mixture into the respiratory tract. The most severe patients are usually in intensive care units, often with impaired respiratory function of varying severity.

Home CPAP - the device is a compressor that delivers a predetermined volume of air, a circuit (hose) and a face mask. This device is used at home mainly for sleep apnea syndrome. Sleep apnea syndrome ("a" - negation, absence of anything, "pnoe" - breathing) is a short-term cessation of breathing during sleep, the pathogenesis of which is the pathological relaxation of the muscles of the oropharynx - the palatine-lingual arches, uvula, soft palate. Relaxed oropharyngeal muscles can narrow the airways significantly or block them altogether. The device only creates pressure in the airways, which prevents them from narrowing.

As for pneumonia, a severe version of its course (which requires assisted ventilation) is an indication for hospitalization in the intensive care unit, because inflammation of the lung tissue significantly impairs the oxygenating function of the lungs and requires an increase in the oxygen concentration in the inhaled gas mixture, which is usually not needed by people with sleep apnea syndrome.

Answer 2
January, 2021

CPAP therapy is not intended for the actual treatment of pneumonia associated with coronavirus infection. However, CPAP therapy can reduce the risk of developing acute respiratory failure caused by complications of coronavirus infection.

CPAP therapy is a method of creating continuous positive airway pressure, which is used to treat obstructive sleep apnea (OSA). In this case, a special compressor is used, which through a tube and a nasal (or nasal mask) creates a constant positive pressure in the airways, which does not allow them to subside during sleep.

There is also a BIPAP therapy technique. It is a method of creating a bi-level positive airway pressure. On inhalation, the device creates a higher pressure, and on exhalation, it decreases it. Thus, not only the opening of the airways is achieved, but also the auxiliary ventilation of the lungs. This method is used to treat OSAS in combination with chronic respiratory failure (for example, in Pickwick syndrome).

There is a published article by Chinese authors, which says that the use of BIPAP or CPAP systems in some cases avoids the need for intubation and mechanical ventilation in patients with pulmonary complications due to COVID-19 [Wang D et al .. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, ].

In the interim guidelines of the Ministry of Health of the Russian Federation for the prevention, diagnosis and treatment of new coronavirus infection 2019-nCoV it is indicated: “In the absence of indications In immediate intubation, to initiate respiratory support, it is advisable to use non-invasive ventilation (NVL) through an ornasal mask according to generally accepted rules with careful monitoring of the PaO2 level or SpO2 value. NVL allows avoiding the development of many mechanical complications, while at the same time providing effective restoration of gas exchange and unloading of the respiratory muscles in patients with acute respiratory failure. It is recommended to consider the possibility of using NVL instead of IVL in patients with preserved consciousness, the ability to cooperate with a doctor and stable hemodynamics. ”

systems for artificial ventilation of the lungs, it is necessary to provide for the active use of CPAP and BIPAP with the threat of acute respiratory failure. This will allow some patients to alleviate the condition and even prevent an unfavorable outcome.

Another important aspect of the problem should be touched upon. It has already been proven that the incidence of acute respiratory failure and the need for mechanical ventilation (ALV) increases dramatically in obese patients. Why? In patients with grade 3 obesity (BMI> 40), the incidence of OSA is about70%, and the frequency of Pickwick syndrome (obesity-hypoventilation syndrome - FH) is 15%.

With OSAS, there can be up to 500 episodes of apnea in 8 hours of sleep, accompanied by sharp drops in blood oxygen saturation. With SOG, not only frequent apnea is noted, but also a sharp drop in the average blood oxygen saturation (saturation) due to a decrease in the excursion of the lungs compressed by fat. The average oxygen saturation can fall below 80%, which in itself is already practically a resuscitation situation.

Thus, the respiratory system is working with obvious overload. It is enough to turn off some part of the lungs from gas exchange against the background of influenza, bronchitis and pneumonia to provoke the rapid development of acute respiratory failure (ARF) during a night's sleep. Further, a cascade process occurs with the development of cardiopulmonary and multiple organ failure in just a few hours. In this situation, even mechanical ventilation is no longer effective.

And before the COVID-19 epidemic, patients with SOG had a high mortality rate (15-25 per year) due to common flu or pneumonia. Since coronavirus infection causes widespread lung damage, the risk of death in patients with FHO increases dramatically.

It has been proven that the use of CPAP and BIPAP significantly reduces the incidence of ARF and mortality in patients with FH. It is only important to understand that these methods must be applied even before infection with COVID-19 and before signs of ODN appear. This increases the compensatory capabilities of the body, improves oxygen saturation and allows you to carry the flu or pneumonia without catastrophic consequences. If a patient with FH is not given CPAP or BIPAP therapy in advance, then his risk of developing pulmonary heart and multiple organ failure in coronavirus pneumonia sharply increases. At the same time, mechanical ventilation is often no longer effective.

Based on the information above, there are several conclusions to be drawn:

  1. In obese patients 2-3 tbsp. there is a high probability of breathing disorders during sleep: obstructive sleep apnea syndrome and obesity-hypoventilation syndrome.
  2. In obese patients 2-3 tbsp. it is advisable to carry out diagnostics for the detection of breathing disorders during sleep (polysomnography, computer somnography, respiratory monitoring). This is especially true during the COVID-19 epidemic.
  3. CPAP or BIPAP therapy should be initiated in patients with identified OSA and FH.
  4. In case of admission to the hospital for coronavirus infection, the patient must continue CPAP or BIPAP therapy. This is especially necessary in patients with FH.
  5. Probably all patients with morbid obesity (BMI> 40) who are admitted to hospital with pneumonia should initiate CPAP or BIPAP therapy, even if the diagnosis of sleep-breathing disorders has not been confirmed before and the patient has no signs of respiratory failure ... These patients are at a very high risk of developing ARF if they are not taken care of.temporarily CPAP or BIPAP therapy.

For more information, see the books:

How to Treat Snoring and Obstructive Sleep Apnea Syndrome - can be downloaded from this link.

Long Term CPAP / BIPAP -therapy at home. Recommendations for patients ”can be downloaded from this link.

For professionals, the book "Non-invasive respiratory support for breathing disorders during sleep" may be of interest. It can be purchased on the website

Consultation on the diagnosis and treatment of sleep breathing disorders can be obtained at our sleep medicine center

Three cries for snoring and apnea.jpg

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