• Sheng ChewNicholas WenNWDepartment of Cardiology, National University Heart Centre, Singapore., Chiew WongRaymond ChingRCDepartment of Cardiology, National University Heart Centre; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Andie Hartanto Djohan, Jinghao Nicholas Ngiam, Ping Chai, Tiong-Cheng Yeo, Huay-Cheem Tan, and Ching-Hui Sia.
• Department of Cardiology, National University Heart Centre, Singapore.
• Singap Med J. 2023 Oct 1; 64 (10): 609615609-615.

IntroductionCountries are mandating the use of face masks to stem the spread of coronavirus disease 2019 (COVID-19). Face mask use has been associated with discomfort due to its effects on thermoregulation, breathing and oxygenation. We evaluated the prevalence and severity of self-reported cardiovascular symptoms before and during face mask use.MethodsThis was a cross-sectional study of 1,001 participants residing in Singapore, who participated in a self-administered questionnaire between 25 April 2020 and 4 May 2020. Symptom severity before and during mask use, and health-seeking behaviour information were collected. The study outcome was self-reported worsening of cardiovascular symptoms and its association with the type of mask worn, duration of mask worn per day, and intensity of physical activities during mask use.ResultsThe most common symptom reported during mask use was dyspnoea. Independent predictors for self-reported cardiovascular symptoms during mask use were moderate-high physical activity during mask use (odds ratio [OR] 1.634, 95% confidence interval [CI] 1.176-2.270, P = 0.003), duration of mask use for ≥3 h (OR 1.672, 95% CI 1.189-2.352, P = 0.003) and type of mask used, after adjusting for age, sex, healthcare-based worker status and presence of comorbidities. N95 mask was associated with worse symptoms when compared to surgical mask. Participants with ≥3 worsening symptoms or worsening dyspnoea, palpitations, fatigue and dizziness were more likely to seek medical help.ConclusionFace mask use has been proven to be an effective way in curbing COVID-19 transmission. However, participants in this study had concerns regarding its use and these concerns should be urgently addressed to enable mask use policies to be enacted.

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