Associations Between Obstructive Sleep Apnea (OSA) and COVID-19 Infection and Hospitalization Among U.S. Adults <strong> </strong>

Abstract

Background: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. Research Question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? Study Design: Cross-sectional survey of a diverse sample of 15,057 U.S. adults Results: COVID-19 infection and hospitalization rates were 38.9% and 2.9% respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socio-economic and comorbid medical conditions, OSA was positively associated with COVID-19 infection (aOR: 1.58, 95%CI: 1.39-1.79) and COVID-19 hospitalization (aOR: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization, but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated, but not symptomatic OSA were more likely to be hospitalized. Interpretation: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization.

Sleep and long COVID: Preexisting sleep issues and the risk of PASC in a large general population using 3 different model definitions

“…27 Previous results from the COPE initiative indicated that receiving a COVID-19 booster vaccination reduced the risk of COVID-19 hospitalization attributable to OSA. 17 In contrast, we did not find that boosted vaccination for COVID-19 affected the odds of developing PASC related to insomnia, poor sleep quality or short sleep duration.…”

“…As done in our previous studies, participants were considered to have symptoms of OSA if they had either of the following combination of symptoms: 1) snoring “three or more times a week” and witnessed apnea or sleepiness “once or twice a week”; 2) witnessed apnea and sleepiness “once or twice a week”. 6,17…”

“…Exposures : Based on our previous analyses in this cohort, we defined a positive history of COVID-19 infection as an affirmative response to having tested positive for COVID-19, a clinical diagnosis of COVID-19, or loss of taste or smell. 6,9,17 Participants were classified as having OSA if they affirmed currently having the condition whether treated or not or if they had two or more symptoms of OSA. 6,9,17 Insomnia was present if endorsed by participants irrespective of treatment status.…”

“…6,9,17 Participants were classified as having OSA if they affirmed currently having the condition whether treated or not or if they had two or more symptoms of OSA. 6,9,17 Insomnia was present if endorsed by participants irrespective of treatment status. Poor sleep quality was defined as being troubled by poor sleep “Much” or “Very Much” or rating their sleep quality as “Fairly Bad” or “Very Bad”.…”

“…The effect of comorbid medical conditions was evaluated by summing the number of conditions reported by the participant (minimum value 0, maximum value 9). 6,9,17 Body mass index (BMI) was calculated using self-reported height and weight as kg/m 2 . Socioeconomic covariates were dichotomized as follows: employment (retired vs. not retired), education (high school or less vs. some college) and income in U.S.…”