Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19

Abstract

Purpose Data from large patient registry studies suggested an increased incidence and increased mortality in coronavirus disease-2019 (COVID-19) in patients with a history of obstructive sleep apnea (OSA). This study aimed to compare the prevalence of OSA in patients with and without COVID-19 among patients admitted to the same hospital in the same time period. In addition, the impact of OSA on clinical outcomes of COVID-19 infection was investigated. Methods Observational cohort study. Clinical data were collected retrospectively from the complete medical records for each patient individually from March 1st 2020 to May 16th 2020. Results A total of 723 patients were diagnosed with COVID-19 and 1161 with non-COVID-19 disease. The prevalence of OSA did not differ between these groups ( n = 49; 6.8% versus n = 66; 5.7%; p = 0.230). In patients with COVID-19, mortality was increased in the group of 49 patients with OSA ( n = 17; 34.7%) compared to 674 COVID-19 patients without OSA ( n = 143; 21.2%; p = 0.028). This increased risk of mortality in COVID-19 patients with OSA (OR = 2.590; 95%CI 1.218–5.507) was independent from Body Mass Index (BMI), male gender, age, diabetes, cardiovascular disease, and obstructive lung disease. Presence of OSA in COVID-19 disease was further associated with an increased length of hospital stay (12.6 ± 15.7 days versus 9.6 ± 9.9 days; p = 0.049). Conclusion The prevalence of OSA did not differ between patients with or without COVID-19, but mortality and hospital length of stay were increased in patients with OSA and comorbid COVID-19. Hence, OSA should be included in COVID-19 risk factor analyses, Clinicians should be aware of the association and the mechanism should be further explored.

Neck Circumference Predicts Mortality in Hospitalized COVID-19 Patients

“…Moreover, we believe that neck circumference could outperform the prognostic predictive value of BMI among COVID-19 patients, being more associated with a specific fat distribution pattern, thus reflecting a “bad” obesity distribution pattern. Interestingly, a large neck circumference has been significantly associated with the prevalence of obstructive sleep apnea syndrome [ 17 ]. According to the literature data, obstructive sleep apnea syndrome occurs in 2–4% of adults, increasing by 2.5 times the risk of sudden death.…”

“…According to the literature data, obstructive sleep apnea syndrome occurs in 2–4% of adults, increasing by 2.5 times the risk of sudden death. When looking at SARS-CoV-2-infected patients, a recent study showed that there was an increased risk of mortality in COVID-19 patients with obstructive sleep apnea syndrome (OR = 2.59; 95% CI 1.218–5.507) independently from BMI, male gender, age, diabetes, cardiovascular diseases, and obstructive lung disease [ 17 ]. It is possible that part of the risk is attributable to the fact that, since gasping is a common phenomenon in patients with obstructive sleep apnea syndrome, this can predispose to aspiration of viral particles [ 18 ].…”

Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19: A quantitative meta-analysis based on adjusted effect estimates

“…In this paper, the authors descriptively reviewed the potential relationship between obstructive sleep apnoea (OSA) and the risk for mortality among patients with coronavirus disease 2019 (COVID-19), but failed to quantitatively address this association. To our knowledge, some original studies reported that OSA was significantly linked to an elevated risk for fatal COVID-19 ( 2 , 3 , 4 ), while some others observed non-significant relationship between OSA and fatal COVID-19 ( 5 , 6 , 7 ). Therefore, there is an urgent need to evaluate the association of OSA with fatal COVID-19 by performing a quantitative meta-analysis.…”

“…383 articles were identified through a preliminary literature search, 152 articles remained after eliminating duplicates, 107 articles were excluded after reading the title and abstract, 45 full-text articles were assessed for eligibility, in the end, 13 articles ( 2 , 3 , 4 , 5 , 6 , 7 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ) with 31,933 COVID-19 patients were included in this study. Of these thirteen studies, four studies were prospective and nine studies were retrospective.…”

Impact of Obstructive Sleep Apnea (OSA) in COVID-19 Survivors, Symptoms Changes Between 4-Months and 1 Year After the COVID-19 Infection

“…To date, most of the data published on the risk factors for the pneumonia in COVID-19 and long-term sequelae (as example: male gender, age, obesity, hypertension, diabetes) are also recognized as clinical risk factor for increased risk of obstructive sleep apnea (OSA) ( 8 – 11 ). However, data about the association between OSA and COVID-19 is limited to few studies, including indirect measures such as questionnaires, or secondary analysis of databases ( 1 , 8 , 12 , 13 ).…”