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Pataka A, Kotoulas S, Sakka E, Katsaounou P, Pappa S. Sleep Dysfunction in COVID-19 Patients: Prevalence, Risk Factors, Mechanisms, and Management. J Pers Med 2021; 11:1203. [PMID: 34834555 PMCID: PMC8618512 DOI: 10.3390/jpm11111203] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022] Open
Abstract
During the COVID-19 pandemic, the need to establish the prevalence of sleep dysfunction and psychological distress, identify predisposing and protective factors, and explore effective management strategies remains an important priority. Evidence to date suggests that a considerable proportion of COVID-19 patients experience significant sleep disturbances (estimated to afflict up to 50-75%) as well as psychological distress such as depression, anxiety, and traumatic stress. Duration of hospitalization, pre-existing mental health concerns, lower absolute lymphocyte count, and increased neutrophil-to-lymphocyte ratio have been all associated with a greater risk of sleep dysfunction in infected and hospitalized patients. Furthermore, in this review, we discuss the link between sleep deprivation, susceptibility to viral infections, and psychosocial wellbeing in relevance to COVID-19 and summarize the existing evidence regarding the presence and role of sleep apnea in infected individuals. Finally, we highlight the importance of suitable interventions in order to prevent and manage sleep dysfunction and avoid long-term physical and psychological implications. Future research should aim to provide high-quality information including in high risk, underserved, or difficult to reach populations and on the long-term consequences and effectiveness of applied interventions.
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Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Seraphim Kotoulas
- Respiratory Failure Unit, G Papanikolaou Hospital Medical School, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece;
| | - Elpitha Sakka
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton BN2 4AT, UK;
| | - Paraskevi Katsaounou
- Department of Respiratory Medicine, First ICU, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Sofia Pappa
- Department of Brain Sciences, Imperial College London, London W12 0NN, UK; or
- West London NHS Trust, London UB2 4SD, UK
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2
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Sahni A, Cao M. Obstructive sleep apnea and severe COVID-19 infection: is there a plausible link? J Clin Sleep Med 2021; 17:2145-2146. [PMID: 34473047 DOI: 10.5664/jcsm.9644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ashima Sahni
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michelle Cao
- Division of Pulmonary, Allergy and Critical Care Medicine and Division of Sleep Medicine, Stanford University School of Medicine, Stanford, California
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3
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Goyal A, Saxena K, Kar A, Khurana A, Bhagtana PK, Sridevi CSKR, Pakhare A. Obstructive sleep apnea is highly prevalent in COVID19 related moderate to severe ARDS survivors: findings of level I polysomnography in a tertiary care hospital. Sleep Med 2021; 91:226-230. [PMID: 34246548 PMCID: PMC8214316 DOI: 10.1016/j.sleep.2021.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/25/2021] [Accepted: 06/11/2021] [Indexed: 12/31/2022]
Abstract
Study objectives Studies have found Obstructive Sleep Apnea (OSA) as a risk factor for increased risk for COVID19 Acute respiratory Distress Syndrome (ARDS); but most of the studies were done in already known patients of OSA. This study was done to find prevalence of OSA in patients with COVID-19 related acute respiratory distress syndrome. Methodology A hospital based longitudinal study was conducted among COVID 19 Intensive Care Unit (ICU) survivors. All consecutive COVID19 with moderate to severe ARDS were evaluated for OSA by Level I Polysomnography (PSG) after 4–6 weeks of discharge. Prevalence of OSA and PSG variables {Total sleep time, Sleep efficiency, sleep stage percentage, Apnea Hypopnea Index (AHI), T90, nadir oxygen} was estimated. Results Out of 103 patients discharged from ICU during study period (October 2020 to 15 December 2020), 67 underwent Level I PSG. Mean Age was 52.6 ± 10.9 years and mean Body Mass Index was 27.5 ± 6.2 kg/m2. Total sleep time was 343.2 ± 86 min, sleep efficiency was 75.9 ± 14.2%. OSA (AHI ≥5) was seen in 65/67 patients and 49 patients had moderate to severe OSA (ie AHI ≥15). Conclusion Moderate-severe OSA was highly prevalent (73%) in COVID19 moderate to severe ARDS survivors. Role of OSA in pathophysiology of COVID19 ARDS needs further evaluation.
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Berdina ON, Madaeva IM, Rychkova LV. [Novel coronavirus disease (COVID-19) and obstructive sleep apnea: age aspects of comorbidity]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:110-115. [PMID: 34078869 DOI: 10.17116/jnevro2021121402110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In connection with the spread of the novel coronavirus infection (COVID-19) pandemic and the increase in the development of severe acute respiratory syndrome, works are published around the world that determined the risk factors for complications and poor outcomes in this disease. Among the main comorbidities in COVID-19, scientists distinguish hypertension, diabetes, obesity, etc. Recently, more and more physicians and researchers are concerned about the high frequency of severe and critical complications of COVID-19 in patients with obstructive sleep apnea (OSA). In this review, we present some data on COVID-19 and OSA in the age aspect, show the general pathophysiological pathways leading to increased systemic inflammation and adverse consequences in the comorbid course of these diseases. Special attention is paid to such studies in the pediatric population, but only a few works of foreign scientists were found that did not reveal the essence of the problem under discussion, which requires further research in this area.
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Affiliation(s)
- O N Berdina
- Scientific Centre for Family Health and Human Reproduction problems, Irkutsk, Russia
| | - I M Madaeva
- Scientific Centre for Family Health and Human Reproduction problems, Irkutsk, Russia
| | - L V Rychkova
- Scientific Centre for Family Health and Human Reproduction problems, Irkutsk, Russia
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Goldstein CA, Rizvydeen M, Conroy DA, O'Brien LM, Gupta G, Somers EC, Sharma P, Golob JL, Troost JP, Burgess HJ. The prevalence and impact of pre-existing sleep disorder diagnoses and objective sleep parameters in patients hospitalized for COVID-19. J Clin Sleep Med 2021; 17:1039-1050. [PMID: 33560208 DOI: 10.5664/jcsm.9132] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea and other sleep disorders overlap with comorbidities associated with poor outcomes related to severe acute respiratory syndrome coronavirus 2 infection. However, the prevalence of obstructive sleep apnea among patients hospitalized for COVID-19 and relationship to outcomes is poorly characterized, and the relevance of other sleep disorders remains unknown. The objective of this study was to identify the prevalence of pre-existing sleep disorders and association with outcomes related to severe COVID-19 illness. METHODS Patients with severe acute respiratory syndrome coronavirus 2 infection admitted to the University of Michigan Hospital System were included. Electronic medical records were queried for sleep disorders diagnostic codes. Data were extracted from polysomnography and home sleep testing in a subgroup with previous diagnostic testing at our center. Logistic regression was used to examine the association of sleep disorders with mechanical ventilation requirement, treatment with vasopressors, and death and Cox proportional hazards regression for time to discharge. RESULTS Among n = 572 adult patients hospitalized for COVID-19, 113 (19.8%) patients had obstructive sleep apnea, 4 patients had central sleep apnea (0.7%), 5 had hypoventilation (0.9%), 63 had insomnia (11.0%), and 22 had restless legs syndrome or periodic limb movements disorder (3.9%). After adjusting for age, sex, body mass index, and race, no significant relationship was apparent between sleep disorders diagnoses or indices of sleep-disordered breathing severity and outcomes. CONCLUSIONS This is the first study to determine the prevalence of obstructive sleep apnea and other sleep disorders in a well-characterized cohort of patients hospitalized for COVID-19. Once hospitalized, a significant contribution of sleep disorders to outcomes was not identified. Therefore, future evaluations should focus on earlier outcomes, such as infection or clinical manifestations after exposure to severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Cathy A Goldstein
- Sleep Disorders Centers, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Muneer Rizvydeen
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Deirdre A Conroy
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Louise M O'Brien
- Sleep Disorders Centers, Department of Neurology, University of Michigan, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gita Gupta
- Sleep Disorders Centers, Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Emily C Somers
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.,Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan
| | - Pratima Sharma
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan L Golob
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan
| | - Helen J Burgess
- Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Nikolic M, Simovic S, Novkovic L, Jokovic V, Djokovic D, Muric N, Bazic Sretenovic D, Jovanovic J, Pantic K, Cekerevac I. Obesity and sleep apnea as a significant comorbidities in COVID-19 - A case report. Obes Res Clin Pract 2021; 15:281-284. [PMID: 33933379 PMCID: PMC8078914 DOI: 10.1016/j.orcp.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
In our paper we aimed to increase the awareness among physicians, concerning coronavirus disease 2019 (COVID-19) severity, especially in patients with specific underlying comorbidities. Obesity is the second most common condition in hospitalized COVID-19 patients. Furthermore it has a major role in the development of obstructive sleep apnoea (OSA), which is highly involved in a severe COVID-19 development and its serious outcomes. Even though obese OSA patients had an increased pulmonary embolism (PE) risk, there is no enough evidence to support the interaction between obesity and OSA regarding PE development in the setting of COVID-19. Our patient is a 45-year-old obese male with COVID-19, who was admitted to the intensive care unit (ICU) with acute respiratory failure requiring high-flow nasal oxygenation. Clinical, laboratory and diagnostic findings pointed on severe COVID-19 form, complicated with PE. After recovery, the diagnosis of OSA was established. With this case, we wanted to alert the physicians on comorbidities, such as obesity and OSA, while those conditions, to some extent, may contribute to worse COVID-19 clinical presentation.
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Affiliation(s)
- Maja Nikolic
- University of Kragujevac, Faculty of Medical Sciences, Department of Physiology, Serbia
| | - Stefan Simovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Cardiology, University Clinical Center Kragujevac, Serbia.
| | - Ljiljana Novkovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
| | - Vuk Jokovic
- Center for Vascular Surgery, University Clinical Center Kragujevac, Serbia
| | - Danijela Djokovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Serbia; Clinic for Psychiatry, University Clinical Center Kragujevac, Serbia
| | - Nemanja Muric
- University of Kragujevac, Faculty of Medical Sciences, Department of Psychiatry, Serbia; Clinic for Psychiatry, University Clinical Center Kragujevac, Serbia
| | - Danijela Bazic Sretenovic
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Internal Medicine, University Clinical Center Kragujevac, Serbia
| | - Jovan Jovanovic
- Clinic for Cardiology, University Clinical Center Kragujevac, Serbia
| | - Katarina Pantic
- Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia; Clinic for Pulmology, University Clinical Center Kragujevac, Serbia
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7
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Hariyanto TI, Kurniawan A. Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis. Sleep Med 2021; 82:47-53. [PMID: 33892451 PMCID: PMC8012298 DOI: 10.1016/j.sleep.2021.03.029] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/04/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
Background Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder which could impair someone's quality of life and is also associated with poor outcomes from many diseases. Currently, the evidence regarding the link between OSA and coronavirus disease 2019 (COVID-19) is still conflicting. This study aims to analyze the relationship between OSA and poor outcomes of COVID-19. Materials and methods We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 10th, 2020. All articles published on COVID-19 and OSA were retrieved. The quality of the study was assessed using the Newcastle–Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software. Results A total of 21 studies with 54,276 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that OSA was associated with composite poor outcome [OR 1.72 (95% CI 1.55–1.91), p < 0.00001, I2 = 36%, random-effect modeling] and its subgroup which comprised of severe COVID-19 [OR 1.70 (95% CI 1.18–2.45), p = 0.005], ICU admissions [OR 1.76 (95% CI 1.51–2.05), p < 0.00001], the need for mechanical ventilation [OR 1.67 (95% CI 1.48–1.88), p < 0.00001], and mortality [OR 1.74 (95% CI 1.39–2.19), p < 0.00001]. Conclusions Extra care and close monitoring should be provided to patients with OSA to minimize the risk of infections. Simple questionnaires such as STOP-Bang questionnaire can be used for screening patients who may be at risk for severe adverse outcomes.
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Affiliation(s)
- Timotius Ivan Hariyanto
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, 15811, Indonesia
| | - Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, 15811, Indonesia.
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Chia G, Barrett H, Patel P, Soni S. One hundred eighteen days on a ventilator: a COVID-19 success story against all odds. BMJ Case Rep 2021; 14:e239631. [PMID: 33782066 PMCID: PMC8009212 DOI: 10.1136/bcr-2020-239631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Emerging data suggest that patients with certain comorbidities requiring intensive care unit (ICU) admission for COVID-19 have a poor prognosis. This report describes a case of a patient with multiple comorbidities who contracted COVID-19 pneumonitis but was successfully weaned off invasive mechanical ventilation after 118 days, despite his admission being complicated by recurrent septic episodes and requirement for advanced cardiovascular support and renal replacement therapy. Of note, our patient received three courses of steroids in total during his ICU stay,and current literature strongly supports the use of steroids in critically unwell patients with COVID-19. To the best of our knowledge, this is the longest reported ventilated time and intensive care/hospital stay for a surviving patient with COVID-19 and highlights the importance of allowing sufficient time for clinical interventions to take effect, even when the prognosis appears bleak.
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Affiliation(s)
- Germaine Chia
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hannah Barrett
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Parind Patel
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sanooj Soni
- Centre for Perioperative Medicine and Critical Care Research, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
- Division of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
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9
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Lin YN, Liu ZR, Li SQ, Li CX, Zhang L, Li N, Sun XW, Li HP, Zhou JP, Li QY. Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review. Nat Sci Sleep 2021; 13:933-966. [PMID: 34234598 PMCID: PMC8253893 DOI: 10.2147/nss.s312037] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/30/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic may exert adverse impacts on sleep among populations, which may raise awareness of the burden of sleep disturbance, and the demand of intervention strategies for different populations. We aimed to summarize the current evidence for the impacts of COVID-19 on sleep in patients with COVID-19, healthcare workers (HWs), and the general population. We searched PubMed and Embase for studies on the prevalence of sleep disturbance. Totally, 86 studies were included in the review, including 16 studies for COVID-19 patients, 34 studies for HWs, and 36 studies for the general population. The prevalence of sleep disturbance was 33.3%-84.7%, and 29.5-40% in hospitalized COVID-19 patients and discharged COVID-19 survivors, respectively. Physiologic and psychological traumatic effects of the infection may interact with environmental factors to increase the risk of sleep disturbance in COVID-19 patients. The prevalence of sleep disturbance was 18.4-84.7% in HWs, and the contributors mainly included high workloads and shift work, occupation-related factors, and psychological factors. The prevalence of sleep disturbance was 17.65-81% in the general population. Physiologic and social-psychological factors contributed to sleep disturbance of the general population during COVID-19 pandemic. In summary, the sleep disturbance was highly prevalent during COVID-19 pandemic. Specific health strategies should be implemented to tackle sleep disturbance.
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Affiliation(s)
- Ying Ni Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhuo Ran Liu
- Department of Thyroid and Vascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Shi Qi Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Chuan Xiang Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Department of Respiratory Medicine, Wuhan No.3 Hospital, Wuhan, 430000, People's Republic of China
| | - Liu Zhang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Ning Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Xian Wen Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Hong Peng Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Jian Ping Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Qing Yun Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.,Institute of Respiratory Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China
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