Coronavirus disease (COVID-19) is a respiratory disease caused by severe infection with the coronavirus 2 (SARS-CoV-2) of the acute respiratory syndrome. A subgroup of COVID-19 patients have a severe form of the disease with hospitalization, respiratory failure, or death. Severe COVID-19 is primarily characterized by shortness of breath. The most common risk factors are age, obesity, cardiovascular disease, diabetes, and poor lung function.
Three small studies reported that obstructive sleep apnea (OSA) could be a potential risk factor for severe COVID-19. OSA is a sleep disorder characterized by repetitive apnea-hypopnea cycles during sleep. This causes shortness of breath and can often lead to difficulty sleeping, severe oxygen desaturation, and an increase in systolic and diastolic blood pressure.
Study: Sleep Apnea is a Risk Factor for Severe COVID-19. Image Credit: Brian Chase / Shutterstock
The most common risk factors for OSA are age, obesity, male gender, and abnormalities in the structure of the upper respiratory tract. With OSA affecting nearly 8% of the population and having a higher prevalence of over 20% in those over 60, the link to the risk of severe COVID-19 infection leading to hospitalization is worrying.
Therefore a research team from the University of Helsinki; Helsinki University Hospital; Broad Institute of MIT and Harvard; and Massachusetts General Hospital, Boston, MA, decided to build on these small studies and test the link between OSA and COVID-19 using a large biobank of patient health data.
The study focused on examining the link between OSA and COVID-19
In their preprint article recently published on the medRxiv * server, the researchers discussed their study, which aimed to test the association between OSA diagnosis and the risk of COVID-19 transmission and severity. Specifically, they wanted to investigate whether OSA increases the risk of severe COVID-19 infection, regardless of other common risk factors such as age, gender, high blood pressure, and diabetes.
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The main aim of the study was to investigate whether OSA patients are at increased risk of contracting COVID-19 and developing the severe form of the disease that leads to hospitalization. The team conducted a retrospective case-control study using the FinnGen Study Cohort, the National Register of Infectious Diseases, the Finnish National Hospital Discharge Register, and the Causes of Death Register.
Details of the OSA diagnosis and infection with COVID-19 of 305 patients were taken from the FinnGen study. All patients tested RT-PCR positive for COVID-19 infection, and 26 (8.5%) of these patients also had OSA. Infections that required hospitalization were considered severe COVID-19. Among the severe COVID-19 patients, 16 (19.3%) people had OSA. In addition, the team used the FinnGen data to analyze additional proven risk factors for OSA and severe COVID-19.
OSA is an independent risk factor for severe COVID-19
The results of the study showed that OSA patients with COVID-19 were five times more likely to develop complications and be hospitalized. OSA is an independent risk factor for severe COVID-19 that requires hospitalization. It increased the risk regardless of age, gender, high blood pressure, body mass index, diabetes, asthma, and chronic obstructive pulmonary disease and coronary heart disease.
“Our results are consistent with previous reports suggesting the link between OSA and COVID-19 because they share a number of comorbidities and risk factors.”
However, OSA was not linked to the risk of COVID-19 infection.
Sleep apnea does not affect the risk of COVID-19 transmission
Based on the analysis performed in this study, the researchers concluded that OSA patients have a 5-fold risk of being hospitalized if they have COVID-19 infection compared to those without OSA. Another important finding, however, was that OSA patients are no higher risk of contracting COVID-19 than people without OSA.
The results suggest that OSA should be viewed as a comorbidity risk factor for developing a severe form of COVID-19 when evaluating suspicious or confirmed COVID-19 patients. These results are in line with previous reports that suggested an association between OSA and severe COVID-19 risk because they share many risk factors and comorbidities.
While previous reports indicated that men are at increased risk for COVID-19, this study found that COVID-19 infection was more common in women. Women with severe COVID-19 infection were also older than men (women – 69.5 years and men – 61.9 years).
“Our results should be interpreted in the context that a registry-based assessment through hospitalization may lack out-of-hospital OSA cases (false negative results) and treatment information such as CPAP or MAD compliance.”
* Important NOTE
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice / health-related behavior, or treated as established information.
- Sleep apnea is a risk factor for severe COVID-19. doi: https://doi.org/10.1101/2020.09.26.20202051,