Sleep apnoea is a risk factor for severe COVID-19

Abstract

BackgroundObstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19.MethodsOSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies.ResultsWe identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10−5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021).ConclusionRisk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.

The association between high risk of sleep apnea, comorbidities, and risk of COVID-19: a population-based international harmonized study

“…However, our study involved general population using an online platform. The participants in our study were younger, with fewer comorbidities, such as hypertension and COPD, than previous studies on COVID-19-hospitalized patients [5][6][7][8][9][10][11][12][13].…”

“…Additionally, our study showed that participants with the following characteristics-high risk of OSA, being male, having diabetes, and having depression-were two to three times more likely to have been hospitalized or to require ICU treatment due to COVID-19. To the best of our knowledge, our study is the first in the literature focusing on hitherto undiagnosed OSA by using the STOP questionnaire and the risk of COVID-19, whereas previous studies examined COVID-19hospitalized patients with physician-diagnosed OSA [5][6][7][8][9][10][11][12][13].…”

“…Previous studies which reported OSA in COVID-19 patients recruited hospitalized patients, usually from one area, with no comparison to participants who had not been afflicted by COVID-19. A few retrospective studies, which examined the association between diagnosed OSA and COVID-19 in electronic medical databases, identified OSA as a risk factor for COVID-19 severity with higher ICU admission and mortality [5][6][7][8][9][10][11][12][13]. Screening patients for OSA is being recommended to aid in decisions for COVID-19 treatment [5,7].…”

“…The severe acute respiratory syndrome coronavirus-2 virus is highly contagious and causes fever, cough, fatigue, respiratory distress, and death. Patients with OSA have a significantly increased risk of severe COVID-19, as well as hospitalization and mortality due to COVID-19 [5][6][7][8][9][10][11][12][13]. OSA has been hypothesized to increase COVID-19 severity and risk of death through proinflammatory pathways [13,14].…”

“…Previous studies on the association between diagnosed OSA and COVID-19 have so far examined hospitalized patients in a single country or retrospectively examined electronic medical records of COVID-19-hospitalized patients with OSA [5][6][7][8][9][10][11][12][13]. To the best of our knowledge, there has been no study on OSA, or at high risk of OSA, and COVID-19 in the general population.…”