Sleep Disordered Breathing Diagnosis and Treatment During the COVID-19 Pandemic: A Nationwide Survey in China

Figures & data

Table 1 Characteristics of the Surveyed Sleep Centers

Number of Centers (Total)	53
Region of centers
North China	18
North East China	2
East China	12
Middle South China	9
South west China	6
North west China	6
Clinical affiliation of the centers
Pulmonary and critical care department	38
Neurology department	2
Otorhinolaryngology department	5
Independent sleep center	8
Patient spectrum of the centers
Focus on sleep disordered breathing	35
Entire spectrum of sleep/wake disorders	18
Number of sleep study bed
0–3	15
4–6	23
≥7	15
Perspective on telemedicine (increase/no change/decrease/uncertain)	34/1/5/13
Self-assessment of knowledge on telemedicine (very good/quite good/not too much/no idea)	8/28/15/2
Obstacles for telemedicine
Technology and equipment	34
Health care policies and regulations	33
Medical insurance payment system	40
Lack of personnel	10

Notes: The mainland China is divided into six administrative zones, which are North China (Beijing, Tianjin, Hebei, Shanxi, Nei Mongo), North East China (Liaoning, Jilin, Heilongjiang), East China (Shanghai, Jiangsu, Zhejiang, Jiangxi, Anhui, Fujian, Shandong), Middle South China (Henan, Hubei, Hunan, Guangdong, Guangxi, Hainan), South west China (Chongqing, Sichuan, Guizhou, Yunnan, Tibet) and North west China (Shanxi, Gansu, Qinghai, Ningxia, Xinjiang).

Figure 1 The distribution of the sleep centers that responded to this survey.

Table 2 Changes in Sleep Service Activities During the COVID-19 Pandemic

	Pre-Pandemic	Feb–Mar	Apr–May	Jun
Patient volume of sleep study (%)	100	10 (0, 20)	50 (30, 69)^b	60 (30, 80)^b
Diagnostic procedures (%)
Polysomnography	50 (32, 80)	0 (0, 10) ^a	25 (10, 50) ^a, b	30 (10, 60) ^a, b
Polygraphy	50 (20, 65)	90 (20, 100)^a	70 (40, 90) ^a	64 (25, 90)
Empiric treatment without study	0 (0, 7.5)	0 (0, 10)	0 (0, 10)	0 (0, 5)
Patient volume of PAP titration (%)	100	5 (0, 20)	30 (10, 65) ^b	50 (10, 80) ^b
Titration procedures (%)
In-lab manual titration	20 (10, 60)	0 (0, 10)^a	10 (0, 32)^a, b	10 (0, 37)^b
In-lab autotitration	50 (20, 85)	50 (0, 92)	50 (8, 88)	55 (10, 89)
Home autotitration	5 (0, 20)	40 (0, 96)	5 (0, 50)	5 (0, 48)
Follow-up method (%)
Clinic	30 (20, 50)	0 (0, 10) ^a	20 (10, 30) ^a, b	20 (10, 30) ^a, b
Telephone	40 (20, 50)	50 (9, 90)	55 (20, 77)	50 (20, 75)
Telemedicine	0 (0, 10)	0 (0, 25)	0 (0, 10)	0 (0, 10)
Without follow-up	25 (5, 40)	40 (10, 70)^a	30 (10, 53)	30 (20, 55)
Number of centers using telemedicine for diagnosis (n)	15	10	16	16
C2C	11	7	12	12
C2P	5	3	5	5
Number of centers using telemedicine for PAP titration (n)	12	9	14	15
C2C	7	4	7	9
C2P	5	5	7	6
Number of centers using telemedicine for follow up (n)	17	13	16	17
Proportion of patients using telemedicine for follow up in the centers practicing this service (%)	10 (10, 23)	20 (10, 40)	20 (15, 40)	10 (10, 30)
Medical staff changes (%)
Physician	100%	50 (30, 60)	50 (30, 83)	50 (30, 100)
Technician and nurse	100%	50 (30, 78)	60 (45, 80)	60 (43, 80)
Physician/technician/nurse in training	100%	0 (0, 0)	0 (0, 18)	0 (0, 23)^b

Notes: ^ap<0.05 compared with pre-pandemic, ^bp<0.05 compared with February-March. Data are presented as the median and interquartile range for numerical variables with a skewed distribution. Comparisons between groups were determined by the Kruskal–Wallis one-way analysis. A value of p<0.05 was considered statistically significant. The patient volumes for sleep study, PAP titration and medical staff before the pandemic was defined as 100%.

Abbreviations: Apr, April; C2C, center to center; C2P, center to patient; Feb, February; Jun, June; Mar, March; PAP, positive airway pressure.

Table 3 Correlates of the Number of Sleep Tests and Proportion of PSG During Different Periods of the Pandemic

Unadjusted Analysis	Feb–Mar Sleep Test (r, p)	Feb–Mar PSG (r, p)	Apr–May Sleep Test (r, p)	Apr–May PSG (r, p)	June Sleep test (r, p)	June PSG (r, p)
Clinical affiliation	0.255 0.065	0.108 0.440	0.223 0.109	0.215 0.121	0.217 0.119	0.187 0.180
Patient spectrum	0.344 0.012	0.123 0.382	0.339 0.013	0.241 0.082	0.332 0.015	0.176 0.208
Number of beds	0.370 0.006	0.197 0.158	0.374 0.006	0.180 0.197	0.346 0.011	0.121 0.389
Local epidemic condition during this period	−0.235 0.090	−0.255 0.066	0.236 0.089	0.172 0.217	0.343 0.012	0.223 0.108
Proportion of PSG beforehand	−0.039 0.780	0.216 0.120	0.040 0.774	0.534 <0.001	0.016 0.910	0.596 <0.001
Physicians during this period	0.058 0.692	−0.220 0.129	0.118 0.399	−0.152 0.277	−0.002 0.986	−0.193 0.167
Technicians during this period	0.075 0.609	0.024 0.871	0.258 0.063	−0.060 0.670	0.132 0.346	−0.153 0.274
Adjusted analysis (Beta, P)
Patient spectrum	0.094 0.570	N/A	0.184 0.208	N/A	12.216 0.216	N/A
Number of beds	0.036 0.008	N/A	0.372 0.007	N/A	13.927 0.029	N/A
Local epidemic condition during this period	−0.082 0.209	N/A	−0.046 0.299	N/A	10.924 0.004	N/A

Notes: The epidemic condition was classified into 7 levels according to the new emerging COVID-19 cases in the local province: level 1≥10,000, level 2=1000–9999, level 3=500–999, level 4=100–499, level 5=10–99, level 6=1–9, level 7=0.

Abbreviations: Apr, April; C2C, center to center; C2P, center to patient; Feb, February; Jun, June; Mar, March; PSG, polysomnography.

Figure 2 Changes in patient volume and mode of sleep study during the pandemic. The length of the column represents the number of sleep studies and the number on the column represents the proportion (median) of sleep study procedure (blue column for polysomnography and orange column for polygraphy).

Table 4 Correlates of the Number of PAP Titration and Proportion of Home Autotitration During Different Periods of the Pandemic

Unadjusted Analysis	Feb–Mar PAP Titration (r, p)	Feb–Mar Home Auto (r, p)	Apr–May PAP Titration (r, p)	Apr–May Home Auto (r, p)	June PAP Titration (r, p)	June Home Auto (r, p)
Clinical affiliation	0.267 0.154	0.114 0.428	−0.010 0.941	0.116 0.418	0.040 0.778	0.032 0.817
Patient spectrum	0.013 0.944	0.097 0.496	0.192 0.168	0.117 0.412	0.267 0.054	0.147 0.292
Number of beds	−0.179 0.344	−0.166 0.243	0.136 0.332	−0.108 0.452	0.150 0.285	−0.123 0.380
Local epidemic condition during this period	0.016 0.935	0.034 0.811	−0.049 0.728	−0.016 0.910	0.289 0.036	−0.011 0.938
Proportion of home autotitration beforehand	0.015 0.915	0.755 <0.001	−0.089 0.533	0.721 <0.001	−0.182 0.201	0.827 <0.001
Physicians during this period	0.007 0.960	0.008 0.959	0.231 0.105	0.151 0.289	0.067 0.636	0.176 0.209
Technicians during this period	−0.052 0.722	−0.312 0.033	0.310 0.024	0.034 0.812	0.297 0.031	0.056 0.692
Adjusted analysis (Beta, p)
Local epidemic condition during this period	N/A	N/A	N/A	N/A	−0.020 0.852	N/A
Proportion of home autotitration beforehand	N/A	1.318 <0.001	N/A	N/A	N/A	N/A
Technicians during this period	N/A	−0.181 0.215	N/A	N/A	1.165 <0.001	N/A

Notes: The epidemic condition was classified into 7 levels according to the new emerging COVID-19 cases in the local province: level 1≥10,000, level 2=1000–9999, level 3=500–999, level 4=100–499, level 5=10–99, level 6=1–9, level 7=0.

Abbreviations: Apr, April; C2C, center to center; C2P, center to patient; Feb, February; Jun, June; Mar, March; PAP, positive airway pressure.

Figure 3 Changes in patient volume and mode of positive airway pressure titration. The length of the column represents the number of titrations and the number on the column represents the proportion (median) of titration procedure (blue column for lab manual titration, orange column for lab auto titration, and grey column for home auto titration).

Figure 4 Changes in laboratory polysomnography and manual titration in the 12 sleep centers in Beijing during the pandemic. *p<0.05 compared with the pre-pandemic level.