Covid and OSA

Guidance from the Department of Health and Social Care, COVID-19 supplement to the infection prevention and control resource for adult social care

Certain procedures are aerosol generating (AGPs), and therefore associated with an increased risk of airborne infection. As our understanding has increased through the COVID pandemic, the list of AGPs and non-AGPs has been updated. Please see the table below from National guidance (Aug 2022):

At the current time (Sept 2022)

Procedures that ARE aerosol generating  Procedures that ARE NOT aerosol generating
  • Tracheal suctioning
  • Tracheostomy removal or insertion
  • Induction of sputum
  • Cough assistance
  • Coughing
  • Use of CPAP
  • Use of NIV (noninvasive ventilation)
  • Use of HFNO (high flow nasal oxygen)
  • Oral or pharyngeal suction
  • Spirometry or peak cough flow


–          Staff and carers should wear enhanced PPE if a patient is suspected or confirmed to have Covid and is undergoing an AGP

–          Staff and carers should be trained and fit-tested for PPE if they will be undertaking an AGP

–          Enhanced PPE is not mandated for non-AGPs, such as care for a patient on CPAP, NIV or HFNO


Hospital admission:

  • Patients coming into hospital can remain on their usual circuits/masks/ humidification
  • Regular COVID testing takes place prior to arranged admissions, and during elective and emergency admissions
  • Patients may be cohorted according to whether they have suspected/ proven COVID


Remote vs face-to-face appointments:

  • Routine face to face appointments have resumed in clinical practice, however many sleep and ventilation patients and staff have found advantages to remote consultations and are continuing with a greater proportion of remote consultations.
  • NIV/CPAP/HFNO are no longer classed as AGPS either in hospital or the community and therefore enhanced PPE is not required even if the patient is Covid positive.
  • Oral/pharyngeal suction is not an AGP.
  • Tracheal suctioning is an AGP.
  • Tracheostomy removal/insertion is an AGP
  • Induction of sputum is an AGP – as this is unclear, we agreed this means MIE (cough assist) is an AGP


  • Staff only need to wear enhanced PPE in the scenario that a patient is suspected or confirmed to have Covid and is receiving either tracheal suctioning, tracheotomy removal/insertion or MIE.
  • Carers still need to be fit tested for PPE if there is a possibility, they will be exposed to one of these scenarios.
  • Patients using NIV or CPAP in clinic do not require any specific management (eg amber clean, isolation) unless they are suspected to have covid.
  • NEAVS patients coming into hospital can remain on their usual circuits/masks.

Although face-to-face care has returned to pre-pandemic practice, many sleep clinics and their patients have found advantages to remote consultations and may be continuing this way of working for the foreseeable future or indeed longer term.

For people admitted to hospital: It is likely that hospitals will want to have a negative covid swab result before you are able to use CPAP on the open ward. Some areas may be more restrictive and require a second negative covid swab on day 3 or 5 before they allow this, due to infection control precautions. However, with the negative swabs, they no longer need to change the mask and tubing circuit or add a bacterial filter. The usual mask and tubing can be used, plus humidifier.

A rapid review of aerosol generating procedures (AGPs)

Seven studies assessed non-invasive ventilation (NIV) and are consistent in suggesting that NIV is not associated with increased aerosol generation and aerosol concentrations were lower than that associated with natural respiratory activities. Therefore, consideration should be given to removing NIV from the extant UK AGP list.

Nine studies examined high-flow nasal oxygen (HFNO). Most of these studies reported that HFNO was either associated with a decrease in aerosol levels or that the aerosol levels were not significantly different to either baseline levels or those generated by coughing. Therefore, consideration should be given to removing HFNO from the extant UK AGP list.

The OSA Alliance is an umbrella organisation to facilitate collaboration between experts across UK patient and professional sleep organisations. Its remit focuses specifically on obstructive sleep apnoea, where a united approach can facilitate excellence in OSA-related care, education and resource. This website has been developed using the experience, expertise and views of the OSA Alliance. It is supported by funding from ResMed who have not been involved in any aspect of the site development.

Contact Us:

To find out more about the OSA Alliance,
please contact:

Gillian Gibbons
m: 07795 342804