Prevalence and Characteristics of Sleep Apnea in Intensive Care Unit Survivors After SARS-CoV-2 Pneumonia

Abstract

Background: Sleep apnea (SA) was reported as possibly exacerbating symptoms of COVID-19, a disease induced by SARS-CoV-2 virus. The same comorbidities are common with both pathologies. This study aimed to estimate the prevalence, characteristics of SA and variation in AHI three months after severe COVID-19 requiring intensive care unit (ICU) admission. Methods: A prospective cohort of patients admitted to ICU for severe COVID-19 underwent an overnight home polygraphy 3 months after onset of symptoms, as part of a comprehensive follow-up program (pulmonary function tests, 6-minute walk tests and chest CTscan). Patients with an apnea hypopnea index (AHI) ≥5 were considered as having SA. We performed a comparative descriptive analysis of 2 subgroups according to the existence, severity of SA and indication for effective SA treatment: patients with absent or mild SA (AHI <15) vs patients with moderate to severe SA (AHI ≥15). Results: Among 68 patients included, 62 (91%) had known comorbidities (34 hypertension, 21 obesity, 20 dyslipidemia, 16 type 2 diabetes). It has been observed a preexisting SA for 13 patients (19.1%). At 3 months, 62 patients (91%) had SA with 85.5% of obstructive events. Twenty-four patients had no or a mild SA (AHI <15) and 44 had moderate to severe SA (AHI ≥15). Ischemic heart disease exclusively affected the moderate to severe SA group. Except for thoracic CT-scan which revealed less honeycomb lesions, COVID-19 symptoms were more severe in the group with moderate to severe SA, requiring a longer curarization, more prone position sessions and more frequent tracheotomy. Conclusion: SA involved 91% of patients in our population at 3 months of severe COVID-19 and was mainly obstructive type. Although SA might be a risk factor as well as consequences of ICU care in severe COVID-19 infection, our results underline the importance of sleep explorations after an ICU stay for this disease.

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

“…Nevertheless, many previous studies have claimed that obstructive sleep apnea is an independent risk factor for poor outcomes of COVID‐19 infection, such as higher mortality rate, higher rate of ventilator use and ICU admission due to respiratory failure and longer hospital stay 8,22–26 . There are several mechanisms could explain the finding.…”

“…Abhishek Goyal et al showed that approximately 73% of moderate‐to‐severe OSA was diagnosed by a PSG in moderate‐to‐severe ARDS in patients with COVID‐19 patients 4–6 weeks after discharge 7 . Ibrahim Traore et al studied 68 cases of patients with severe COVID‐19 who had been admitted to an ICU, and found that 91% of the patients experienced sleep apnea 3 months after the onset of symptoms, with most patients of the obstructive type 8 . In the study by Schwarzl et al 69 COVID‐19 patients, 16 patients (33.3%) were diagnosed with mild OSA, 10 (20.8%) were diagnosed with moderate OSA, and eight patients (16.7%) were diagnosed with severe OSA (AHI ≥ 15).…”

Clinical Approach to Patients with COVID-19 and Unrecognized Obstructive Sleep Apnea

“…Compromised respiratory function can lead to a decreased lung capacity, impaired mucociliary clearance and weakened immune response, making individuals more susceptible to respiratory infections like pneumonia. The intermittent hypoxia and oxidative stress associated with OSA can further exacerbate inflammation and tissue damage in the lungs, worsening the severity and outcomes of respiratory illnesses [11,12]. It has also been proven that unrecognized OSA adversely affects patients with COVID-19 pneumonia.…”