November 15, 2021 – People with insomnia are no more likely than other adults to contract the coronavirus and develop COVID-19. However, if they are infected, they have a 31% higher risk of being hospitalized or dying from the disease, new research shows.
Investigators examined nearly 360,000 patients tested for COVID-19 on the Cleveland Clinic’s system. This group included 5400 people who also completed a sleep study.
They also considered other factors that could alter the risk of COVID-19, including obesity, heart and lung diseases, cancer, and smoking.
The study was published in JAMA Network Open on November 10th.
When asked if she was surprised by the 31% increased risk,
Cinthya Pena Orbea, MD,
says: “Although this was in agreement with our a (existing) hypotheses and we were careful to take lung disease and smoking history into account, we nevertheless identified a statistically significant association.”
Pena Orbea is a Sleep Disorders Center Associate and Assistant Professor of Medicine at Lerner College of Medicine at Cleveland Clinic.
The study is important because it helps identify another group at potential risk for worse outcomes from COVID-19 and can help allocate resources and resources when needed, said lead study author Reena Mehra, MD, director of sleep disorder research at the Cleveland Clinic, in a press release.
“As the COVID-19 pandemic continues and the disease varies greatly from patient to patient, improving our ability to predict who will have more severe illnesses is critical,” she said.
The study can help doctors adapt. “Should a patient with sleep apnea develop COVID19 infection, perhaps they should be prioritized or triaged to receive anti-COVID therapies that have sometimes been scarce,” said Indira Gurubhagavatula, MD, MPH, chair of the American Academy of Sleep Medicine’s COVID-19 Task Force, says.
Exact mechanism a mystery
Why people with sleep disorders may develop more severe COVID-19 remains unknown, but inflammation could play a role, Mehra noted.
Gurubhagavatula says that makes sense.
“We know that people who develop severe COVID-19 infection appear to do so because of a ‘cytokine storm,’ an overwhelming burden of inflammation that results in injury to organs, including lung tissue,” she says.
“We also know that sleep apnea itself causes increased inflammation,” says Gurubhagavatula.
However, previous studies seem to agree that inflammation may be key. For example, other researchers have linked low blood oxygen levels to signs of inflammation, including higher white blood cell counts, in people with COVID-19.
It could also have direct effects on the lungs.
The research also provides important clues on how to move forward in treating the large population of patients with sleep apnea and COVID-19 infection, says Gurubhagavatula.
Unanswered questions include: Should we encourage patients receiving CPAP to make full use of their equipment to limit their risk of developing worse outcomes from COVID-19? Should we give priority over therapy for the infection to patients with obstructive sleep apnea who develop COVID-19?
Pena Orbea and colleagues plan to continue this research.