SARS-CoV-2 Causing Transient Central Sleep Apnea in Patients Treated for Obstructive Sleep Apnea with Continuous Positive Airway Pressure

Abstract

Case series Patients: Female, 41-year-old • Male, 34-year-old Final Diagnosis: Central sleep apnea • obstructive sleep apnea Symptoms: Transient central sleep apnea Medication: — Clinical Procedure: — Specialty: Family Medicine Objective: Unusual clinical course Background: SARS-CoV-2 has globally affected humanity and devastated many families. Here, we attempt to identify which diseases are independent risk factors for severe SARS-CoV-2. There have been multiple studies that have evaluated the impact of obstructive sleep apnea (OSA) on SARS-CoV-2 outcomes, suggesting that OSA is an independent risk factor. SARS-CoV-2 has also been suggested to invade the central nervous system and be responsible for neurological signs and decreasing central respiratory drive. Central sleep apnea (CSA) is defined when apneas and hypopneas are associated with absent or reduced ventilatory effort, respectively, due to diminished central respiratory drive. Case Reports: Here, we describe 2 cases involving patients with OSA that developed transient central sleep apnea after being diagnosed with SARS-CoV-2 by polymerase chain reaction. They had similar past medical histories and presentation of illness. The differences included compliance of continuous positive airway pressure (CPAP), recovery, and severity of central sleep index. We review and address alternate causes for the development of CSA. We hypothesize that continuous and compliant use of CPAP machines may be beneficial in reducing recovery and severity of SARS-CoV-2. Conclusions: Our case report calls attention to the acquired central respiratory drive neurological complication associated with SARS-CoV-2. Our case report highlights the plausible existence of a relationship between development of central respiratory drive leading to CSA and SARS-CoV-2 infection. Further studies are needed to explore this relationship, including evaluating whether CSA occurs in SARS-CoV-2 patients with no history of OSA.

Sleep and critical illness: a review

“…Literature also alludes to a prevalence of CSA in the setting of COVID infection. While in the prospective study noting this, the patients all had cardiac risk factors that may have predisposed to CSA (147), there are case reports of CSA with periodic breathing after COVID-infection seen in the absence of typical risk factors or medications (148)(149)(150). The SARS Cov-2 virus is theorized to cause central nervous system (CNS) dysfunction through direct infection of the nervous system, induction of a hypercoagulable state, or immune-mediated inflammatory processes [(151, 152); Figure 2].…”