Snoring and obstructive sleep apnoea as risk factors in SARS-Cov-2: can nasal CPAP during sleep reduce pneumonia risk?
Snoring and obstructive sleep apnoea as risk factors in SARS-Cov-2: can nasal CPAP during sleep reduce pneumonia risk?
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DOI：
10.1007/s41105-020-00295-5
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发表时间：
2021
影响因子：
1.1
通讯作者：
Sullivan CE
中科院分区：
文献类型：
--
作者：
Sullivan CE
高龄、高血压、肥胖和糖尿病是COVID 19严重疾病的主要风险因素。然而，打鼾和阻塞性睡眠呼吸暂停（OSA），未被识别或报告不足[1]，发生在这些合并症的50%以上[2]，并且是肺炎的已知风险因素。初步报告证实OSA与严重COVID 19疾病之间存在关联[3]。睡眠期间的吸气是打鼾和睡眠呼吸暂停增加肺炎易感性的几种途径之一[4]。误吸倾向随着年龄的增长而增加，与年龄相关的咽功能恶化。呼吸暂停事件和打鼾的咽部气道振动，加上强烈的吸气努力，是能够将大量载病毒的唾液和粘液从鼻咽气道吸入下气道和肺的强大机制。COVID 19中斑片状不均匀肺部变化的早期报告高度提示吸入。在一项优雅的研究中，Hou et al. [5]提供了吸入是导致病毒性肺炎的主要机制的证据。虽然有些人建议暂停使用鼻正压治疗（CPAP）和无创正压通气（NIV），因为存在病毒传播的风险[6]，但通过面罩或头盔进行氧气的CPAP已成为COVID呼吸衰竭管理的主要部分，有报告表明，许多肺炎患者避免完全插管[7，8]。在那些已经患上肺炎的人中，正压的好处在于它在维持肺泡空气空间进行气体交换方面的作用，有助于防止气道闭合和肺泡损失。
Old age, hypertension, obesity and diabetes are the major risk factors for severe disease with COVID 19. However, snoring and obstructive sleep apnoea (OSA), unrecognised, or under reported [1], occurs in over 50% of these comorbidities [2], and is a known risk factor for pneumonia. Preliminary reports confirm an association between OSA and severe COVID 19 disease [3]. Aspiration during sleep is among several pathways by which snoring, and sleep apnoea increases vulnerability to pneumonia [4]. The propensity for aspiration increases with age related deterioration in pharyngeal competence. Apnoeic events, and the vibrating pharyngeal airway of snoring, coupled with strong inspiratory efforts, are powerful mechanisms capable of sucking large amount of viral loaded saliva and mucus from the nasopharyngeal airway into the lower airways and lungs. The early reports of patchy non-uniform pneumonic changes in COVID 19 is highly suggestive of aspiration. In an elegant study, Hou et al.[5] provide evidence for aspiration as a major mechanism leading to viral pneumonia.While some have recommended suspending the use of nasal positive pressure therapy (CPAP) and non-invasive positive pressure ventilation (NIV) because of the risk of viral spread [6], CPAP with oxygen via a face mask or helmet has become a major part of the management of the COVID respiratory failure, with reports suggesting that many pneumonia patients avoid full intubation [7, 8]. In those who already have developed pneumonia, the benefit of the positive pressure is in its role in maintaining alveolar air spaces for gas exchange, helping to prevent airway closure and alveolar loss.
影响因子：
24.3
作者：
Hui, David S.;Chow, Benny K.;Chan, Matthew T. V.
通讯作者：
Chan, Matthew T. V.
影响因子：
8.3
作者：
Genta PR;Kaminska M;Edwards BA;Ebben MR;Krieger AC;Tamisier R;Ye L;Weaver TE;Vanderveken OM;Lorenzi-Filho G;DeYoung P;Hevener W;Strollo P
通讯作者：
Strollo P
影响因子：
3.7
作者：
Chiner, Eusebi;Llombart, Monica;Barbe, Ferran
通讯作者：
Barbe, Ferran