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The attenuation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, at least in Italy, allows a gradual resumption of diagnostic and therapeutic activities for sleep respiratory disorders. The knowledge on this new disorder is growing fast, but our experience is still limited and when a physician cannot rely on evidence-based medicine, the experience of his peers can support the decision-making and operational process of reopening sleep laboratories. The aim of this paper is to focus on the safety of patients and operators accessing hospitals and the practice of diagnosing and treating sleep-related respiratory disorders. The whole process requires a careful plan, starting with a triage preceding the access to the facility, to minimize the risk of infection. Preparation of the medical record can be performed through standard questionnaires administered over the phone or by e-mail, including an assessment of the COVID-19 risk. The home sleep test should include single-patient sensors or easy-to-sanitize material. The use of nasal cannulas is discouraged in view of the risk of the virus colonizing the internal reading chamber, since no filter has been tested and certified to be used extensively for coronavirus due to its small size. The adaptation to positive airway pressure (PAP) treatment can also be performed mainly using telemedicine procedures. In the adaptation session, the mask should be new or correctly sanitized and the PAP device, without a humidifier, should be protected by an antibacterial/antiviral filter, then sanitized and reassigned after at least 4 days since SARS-CoV-2 was detected on some surfaces up to 72 h after. Identification of pressure should preferably be performed by telemedicine. The patient should be informed of the risk of spreading the disease in the family environment through droplets and how to reduce this risk. The follow-up phase can again be performed mainly by telemedicine both for problem solving and the collection of data. Public access to hospital should be minimized and granted to patients only. Constant monitoring of institutional communications will help in implementing the necessary recommendations.

Continuous positive airway pressure (CPAP) therapy provides a pneumatic splinting of the upper airways in obstructive sleep apnea (OSA), but adherence remains a significant problem that physicians should monitor and follow carefully. Automatic CPAP systems (APAP) have been developed in an attempt to optimize adherence to therapy. They continuosly modulate the pressure during the night according to the patient needs, keeping the upper airways clear while reducing the average pressure delivered.

The pathophysiological mechanism underlying the upper airways obstruction has underlined the relevance of airflow waves analysis during nocturnal diagnostic examination in order of better phenotyping Osbtructive Sleep Apnea subjects. The use of nasal cannulas during nocturnal polysomnography or cardiorespiratory monitoring to detect the airflow of patients with obstructive sleep apnea allows detecting a semiquantitative airflow shape; this gives us the possibility to analyze the morphology of airflow shape during regular and partial upper airway obstruction, to obtain pieces of information on upper airway morphology during the whole respiratory cycle. The analysis of the different airflow shapes during the night provides information on the different sites of the upper airway obstruction (palate, tongue, pharynx, and epiglottis) also concerning the body position or the sleep stage. The articles taken into account in this review actively contributed to clarifying this connection. Therefore, the airflow analysis recorded with the nasal cannulas can be used as an inexpensive and noninvasive tool to phenotype the patients and optimize the therapeutic approach by identification of pharyngeal structure that causes collapse during spontaneous sleep.

Continuous positive airway pressure (CPAP) therapy provides a pneumatic splinting of the upper airways in obstructive sleep apnea (OSA). In spite of several CPAP therapy benefits, adherence remains a major problem than physician should monitor carrefully verify. Common interface-related side effects may contribute to therapy failure. The use of CPAP telemonitoring with automated feedback messaging is an evaluable method to improve patient's adherence.