Early application of continuous positive airway pressure in COVID-19 patients at risk of obstructive sleep apnea

Abstract

Abstract Context Respiratory support is an essential part in treating COVID-19 patients at risk for developing respiratory failure, and this become certain if associated with other comorbidities specifically obstructive sleep apnea (OSA). Aim To evaluate the role of early use of continuous positive airway pressure (CPAP) in management of moderate to severe COVID-19 patients at risk of OSA. Settings and design This was experimental clinical trial. Patients and methods Eighty (80) patients with moderate to severe COVID-19 at risk of OSA were enrolled. They were simply randomized into two equal groups: non-CPAP group and CPAP group. Non-CPAP group will receive medical treatment plus oxygen therapy according to recommendation of protocol of the Egyptian Ministry of Health 2020 and CPAP group as in non-CPAP group plus using CPAP. Results Our findings showed that there were higher percentages in hospital deaths and longer duration of hospital stay as well as increased need for invasive mechanical ventilation in non-CPAP group compared to CPAP group patients: (P-value = 0.03), (P-value = 0.04), and (P-value = 0.01), respectively. Also, there was a significant difference on PH, CO2, HCO3, and D-dimer values on both groups on admission and during follow-up with notable decrease in their values in CPAP group compared to non-CPAP group: (P-value = 0.04), (P-value = 0.003), (P-value = 0.001), and (P-value = 0.001), respectively. Conclusion Early CPAP therapy for moderate and severe COVID-19 hospitalized patients with risk of OSA could improve patient’s survival, shorten hospital stay, and decrease need for invasive mechanical ventilation. Trial registration Clinicaltrials.gov/NCT05934916. Registered 6 July 2023 — retrospectively registered.