key: cord-0909561-icou1i5s authors: Machado, Calixto; Brock, Brandon; Machado, Yanín; Chinchilla, Mauricio title: An early prevention of hypoxemia in COVID-19 patients complaining obstructive sleep apnea date: 2021-06-07 journal: Sleep Med DOI: 10.1016/j.sleep.2021.05.045 sha: 58c5972b20e1314ea508cd9626c497ac10b8d423 doc_id: 909561 cord_uid: icou1i5s nan We read with interest the paper of Hariyanto and Kurniawan about obstructive sleep apnea (OSA) and outcomes from COVID-19 disease. [1] The most dreadful complication during of COVID-19 is the cytokine storm (CS). Dr. Machado has called the attention about the close relationship between hypoxemia and the CS, suggesting the needs to prevent periods of hypoxemia in early stages of COVID-19. This is even more crucial in patients who suffer OSA. [2, 3] OSA is commonly related to obesity, which is considered an important risk factor for severe COVID-19. OSA leads to repetitive airway collapse with apnea/hypopnea and hypoxia during sleep. Hypoxia/re-oxygenation during each apnea episode in OSA patients worsens hypoxemia aggravating the CS. [2] Nonetheless, considering a day-by-day clinical evolution, short and slight periods of hypoxemia begin even since the first day, when persistent cough and/or short breath begin. Afterward, the breathing difficulty might worsen leading to an augmentation of periods of hypoxemia. Persistent cough, amongst other symptoms, has been considered a strong predictor of disease worsening. Hypoxia-inducible factor-1α (HIF-1α) and nuclear factor-κB (NF-κB) are two hypoxia-responsive transcription factors fully involved on the triggering effect of hypoxemia on CS development. [2] [3] [4] [5] The use of continuous positive pressure (CPAP) equipment is providing growing evidence that this non-invasive (NIV) method may benefit patients early In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are related to the content of your manuscript. "Related" means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so. The following questions apply to the author's relationships/activities/interests as they relate to the current manuscript only. In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are related to the content of your manuscript. "Related" means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so. The following questions apply to the author's relationships/activities/interests as they relate to the current manuscript only. In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items, the time frame for disclosure is the past 36 months. Please place an "X" next to the following statement to indicate your agreement: In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are related to the content of your manuscript. "Related" means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so. The following questions apply to the author's relationships/activities/interests as they relate to the current manuscript only. In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items, the time frame for disclosure is the past 36 months. Name all entities with whom you have this relationship or indicate none (add rows as needed) Specifications/Comments (e.g., if payments were made to you or to your institution) Time frame: Since the initial planning of the work 1 All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) No time limit for this item. In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are related to the content of your manuscript. "Related" means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so. The following questions apply to the author's relationships/activities/interests as they relate to the current manuscript only. Please place an "X" next to the following statement to indicate your agreement: J o u r n a l P r e -p r o o f Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis Dangers and management of obstructive sleep apnea syndrome in COVID-19 patients Therapy for Early COVID-19: A Critical Need COVID-19 In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items, the time frame for disclosure is the past 36 months. Name all entities with whom you have this relationship or indicate none (add rows as needed) Specifications/Comments (e.g., if payments were made to you or to your institution) Time frame: Since the initial planning of the work 1All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) No time limit for this item. In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are related to the content of your manuscript. "Related" means any relation with for-profit or not-for-profit third parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so.The following questions apply to the author's relationships/activities/interests as they relate to the current manuscript only. In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items, the time frame for disclosure is the past 36 months. Please place an "X" next to the following statement to indicate your agreement:_X__ I certify that I have answered every question and have not altered the wording of any of the questions on this form.