Severity of Sleep Apnea and COVID‐19 Illness

Abstract

Objective To characterize the relationship between severity of sleep apnea and coronavirus disease 2019 (COVID-19) hospitalization and severe illness. Study Design Retrospective cohort study. Setting Montefiore Health System in the Bronx, New York. Methods The data set consisted of adult patients with an active diagnosis of obstructive sleep apnea in the past 2 years and a positive severe acute respiratory syndrome coronavirus 2 quantitative polymerase chain reaction test at our institution between March 16, 2020, and May 26, 2020. Sleep apnea severity and continuous positive airway pressure compliance data were abstracted from the electronic medical record. The International Classification of Diseases, 10th Revision was used to classify comorbidities. Results A total of 461 patients with sleep apnea tested positive for COVID-19, of whom 149 were excluded for missing data in the electronic medical record. Patients with moderate and severe sleep apnea had higher rates of COVID-19 hospitalization compared to those with mild sleep apnea ( P = .003). This association was reduced when accounting for confounders, most notably the Charlson Comorbidity Index, a measure of comorbid illness burden. Moderate and severe sleep apnea were associated with increased Charlson Comorbidity Indices, compared to mild sleep apnea ( P = .01). Sleep apnea severity was not associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death. Conclusion Sleep apnea severity was associated with the Charlson Comorbidity Index and may be a risk factor for COVID-19 hospitalization. We found no evidence that sleep apnea severity among hospitalized patients was associated with a composite outcome of mechanical ventilation, intensive care unit admission, and death.

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

“…The principal finding in our study was that OSA is associated with COVID-19 infection and hospitalization after adjustment for multiple medical comorbidities including BMI. Our results are consistent with many other studies demonstrating that OSA appears to be a risk factor for COVID-19 infection or hospitalization [5][6][7][8]10,12,[14][15][16][17]31,32 as for influenza. 33 However, these prior studies utilized hospital records or other databases to identify COVID-19 cases with or without OSA and in some cases were susceptible to collider bias.…”

Age-adjusted Charlson Comorbidity Index as a predictor of all-cause mortality risk in older adult patients with obstructive sleep apnea: a prospective cohort analysis

“…Levine et al[16]reported that the CCI signi cantly correlated with the physical function subscale of the Short Form-36(r s = − 0.39, P < 0.001) and is a good predictor of the SF-36 physical function score in patients with sleep apnea. Kravitz et al [17] showed that the CCI is a signi cant risk factor for coronavirus disease-related hospitalization of patients with sleep apnea (aOR = 1.45, 95% CI 1.19-1.81, P = 0.0006). Tang et al…”

Obstructive Sleep Apnea as a Risk Factor for COVID-19 Severity—The Gut Microbiome as a Common Player Mediating Systemic Inflammation via Gut Barrier Dysfunction

“…However, their sample size was limited, and this was likely a contributing factor. Kravitz et al [23] concluded that patients with moderate or severe OSA had a higher rate of COVID-19 hospitalization compared to those with mild sleep apnea. However, the association was weakened when adjusting for confounders.…”