In Icelandic patients, obstructive sleep apnea was associated with a two-fold increased risk of severe COVID-19 that required hospitalization or death after considering obesity and other comorbidities.
The occurrence of obstructive sleep apnea (OSA) regardless of obesity or other comorbidities can double the risk of adverse events related to COVID-19, including hospitalization and death. The results were recently published in Sleep.
In the context of several comorbidities known to worsen the risk of severe COVID-19, OSA has also been suggested as an independent risk factor for adverse outcomes, but researchers note that clinical data reflecting the general population has been scarce .
“Most studies have suggested an association but have been limited by highly selective study populations and / or the inability to adequately adjust to key confounders,” they wrote. “Confounding is particularly important as OSA is known to be strongly associated with males, obesity, diabetes mellitus, and heart failure; These are all well-established risk factors for severe COVID-19. “
To further evaluate OSA as a potential independent risk factor for severe COVID-19, which is defined as the combined outcome of hospitalization and death, the study authors examined a population-based cohort of community-based Icelandic citizens aged 18 and over who. the virus was diagnosed in 2020 (N = 4756).
Data on demographics, comorbidities and outcomes of COVID-19 were obtained from centralized national registries, with the diagnosis of OSA being retrieved from the centralized registry of the sleep department of Landspitali – The National University Hospital (LUH).
Since all Icelandic COVID-19 positive individuals were being treated at the time of diagnosis in the LUH COVID-19 outpatient clinic – the only referral center for OSA diagnosis in Iceland and the only provider of positive airway pressure (PAP) treatments – researchers also searched to investigate whether the risk of severe COVID-19 disease was reduced in the subgroup of patients with OSA who were treated with a PAP machine.
Of the patients diagnosed with COVID-19, 185 (3.9%) had a diagnosis of OSA. Compared to patients without OSA, the patients with this disease were older (median age 59 vs. 39 years; P <0.001), had a higher body mass index (BMI; median 32 vs. 26; P <0.001) and were more likely to be male (72% vs. 51%; P <0.001) and more often suffer from high blood pressure (44% vs. 11%; P <0.001), diabetes mellitus (18% vs. 3%; P <0.001), chronic kidney disease (9% vs. 2%; P <0.001), chronic obstructive pulmonary disease (6% vs. 1%; P <0.001) and heart failure (5% vs. 1%; P <0.001).
A total of 238 were hospitalized or died, 38 of them with OSA. After adjusting for age, gender, and BMI, OSA was associated with a more than 2-fold increased risk of severe COVID-19 (OR 2.2; 95% CI 1.4–3.5). The researchers then further corrected for demographics and various comorbidities, with the risk of severe COVID-19 in patients with OSA being slightly reduced but still doubling (OR 2.0; 95% CI 1.2-3.2) im Compared to patients without OSA.
PAP treatment has not been found to change the risk of developing severe COVID-19 in patients with OSA.
Regarding the study results, the researchers said that due to the nationwide study design and the unselected cohort of people with SARS-CoV-2 infection, the results are likely representative of the general population. “Larger studies are needed to further evaluate various phenotypes of OSA, examine possible pathophysiological mechanisms, and examine the effect of PAP treatment on outcomes of COVID-19,” they concluded.
Rögnvaldsson KG, Eyþorsson ES, Emilsson OI, et al. Obstructive sleep apnea is an independent risk factor for severe COVID-19: a population-based study. Sleep. Published online on November 17, 2021. doi: 10.1093 / sleep / zsab272