Association between undiagnosed obstructive sleep apnea and severe course of COVID-19: a prospective observational study

Abstract

Purpose Obstructive sleep apnea (OSA) is associated with many long-term health consequences. We hypothesized that previously unrecognized and untreated OSA may be associated with more severe respiratory failure in hospitalized patients with COVID-19. Methods Patients hospitalized in the Pulmonology Department with confirmed COVID-19, University Hospital in Kraków, Poland, between September 2020 and April 2021 were enrolled. OSA screening questionnaires including Epworth Sleepiness Scale (ESS), STOP-BANG, Berlin questionaire (BQ), OSA-50, and No-SAS were completed. Polygraphy was performed after > 24 h without requirement for supplemental oxygen. Results Of 125 patients with median age of 61.0 years, 71% of whom were male. OSA was diagnosed in 103 patients (82%) and was categorized as mild, moderate, and severe in 41 (33%), 30 (24%), and 32 (26%), respectively. Advanced respiratory support was introduced in 85 patients (68%), and 8 (7%) patients eventually required intubation. Multivariable analysis revealed that increased risk of requirement for advanced respiratory support was associated with higher respiratory event index (OR 1.03, 95%CI 1.00 to 1.07), oxygen desaturation index (OR 1.05, 95%CI 1.02 to 1.10), and hypoxic burden (1.02 95% CI 1.00 to 1.03) and lower minimal SpO2 (OR 0.89, 95%CI 0.81 to 0.98), but not with results of OSA screening tools like BQ score (OR 0.66, 95%CI 0.38 to 1.16), STOP-BANG score (OR 0.73, 95%CI 0.51 to 1.01), NoSAS score (OR 1.01, 95%CI 0.87 to 1.18), or OSA50 score (OR 0.84, 95%CI 0.70 to 1.01). Conclusion Previously undiagnosed OSA was common among hospitalized patients who survived the acute phase of COVID-19. The degree of OSA was associated with the severity of respiratory failure.

The prevalence of obstructive sleep apnea syndrome after COVID‐19 infection

“…It is worth mentioning that overweight and obesity increased the risk of hospitalization and the death rate associated with COVID‐19, resulting in a significant increase in the rate of seeking medical care 31,34 . When patients with higher BMI survived from severe COVID‐19 infection complications, they may need longer recovery time and obstructive sleep apnea may be diagnosed during the long‐term follow up 31,34,35 . Therefore, it is reasonable to assume that the higher BMI of the patients, the higher the chance of being diagnosed with obstructive sleep apnea after being infected with COVID‐19.…”

“…31,34 When patients with higher BMI survived from severe COVID-19 infection complications, they may need longer recovery time and obstructive sleep apnea may be diagnosed during the long-term follow up. 31,34,35 Therefore, it is reasonable to assume that the higher BMI of the patients, the higher the chance of being diagnosed with obstructive sleep apnea after being infected with COVID-19. There are several merits in this study.…”