Does CPAP increase the risk of respiratory infections?

Hey Sleep Warrior,

Today I’m discussing an important question:  Could the use of your PAP device increase the risk of respiratory infections? A question not without gravity, especially in a time of global respiratory pandemics.

When CPAP first came out, there was concern that drying out of your airways would decrease the mucosal barrier to bacteria and increase the risk of infection. So, a humidifier was added to decrease the drying out. Then, there was concern that the humidifier, along with a heated tube carrying moist air, may harbor pathogens that could be blown into your airways. It’s no wonder there is speculation and concern around this topic. 

So, I did some digging into the research, and the medical consensus is that using a CPAP won’t give you a respiratory infection.   One study that came out just this month sought to explore this very question. It investigated if there was an increase in respiratory infections before and after starting PAP therapy among adults with OSA.

482 adult patients undergoing PAP titration at a large academic sleep center were closely monitored. Researchers compared the frequency of reported respiratory infections for two years before and two years after participants began using PAP therapy. 

The findings? There was no significant association between PAP therapy use and increased respiratory infections. A relief, indeed, for those who rely on these devices for a restful night’s sleep.

So, what does this mean for PAP users and those considering starting PAP therapy? 

Again, the medical consensus is that using a CPAP won’t give you a respiratory infection. 

However, bacteria and other organisms can grow on the different parts of your machine - namely the mask, tubing, and humidifier chamber, and we do know that people have developed various infections from inadequately cleaned machines. 

So, it is important to regularly clean your device, especially during the cold and flu season. 

In conclusion, I believe that untreated sleep apnea, particularly moderate to severe OSA, poses a significantly higher risk of leading to an infection than any potential risk from using a machine. However, it's essential for users to maintain their machines' cleanliness to ensure safety. 

Stay tuned for next week's discussion on whether or not to use your machine during an active respiratory infection.

Thanks for being here, I’ll see you next week! 

Citation of study discussed in today’s video:
Gavidia R, Shieu MM, Dunietz GL, Braley TJ. Respiratory infection risk in positive airway pressure therapy users: a retrospective cohort study. J Clin Sleep Med. 2023;19(10):1769–1773.  https://doi.org/10.5664/jcsm.10670