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

Chung, Frances; Waseem, Rida; Pham, Chi; Penzel, Thomas; Han, Fang; Bjorvatn, Bjørn; Morin, Charles M.; Holzinger, Brigitte; Espie, Colin A.; Benedict, Christian; Cedernaes, Jonathan; Saaresranta, Tarja; Wing, Yun Kwok; Nadorff, Michael R.; Dauvilliers, Yves; Gennaro, Luigi De; Plazzi, G.; Merikanto, Ilona; Matsui, Kentaro; Léger, Damien; Siemiński, Mariusz; Mota-Rolim, Sérgio A.; Inoue, Yuichi; Partinen, Markku; Chan, Ngan Yin; Bolstad, Courtney J.; Schneider, Jules; Huang, Ying; Fernandes, Ana Paula Andrade

doi:10.1007/s11325-021-02373-5

Cited by 39 publications

(38 citation statements)

References 36 publications

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“…Among the 149 eligible articles, 227,351,954 participants were included in our meta-analysis; and 89,235,737 were COVID-19 patients. We included 27 studies (132,727,798 participants) for susceptibility [ [20] , [21] , [22] , [23] , [24] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [108] , [109] , [110] , [111] , [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , 132 , 166 ], 56 studies (83,097,968 participants) for illness severity [ 21 , 24 , 28 , 31 , 32 , 34 , [38] , [39] , [40] , [41] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , 83 , 108 , 110 , 116 , 117 ...…”

Section: Resultsmentioning

confidence: 99%

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

Liu

Yan³

et al. 2021

EClinicalMedicine

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102

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Background Coronavirus disease 2019 (COVID-19) has evolved into a worldwide pandemic, and has been found to be closely associated with mental and neurological disorders. We aimed to comprehensively quantify the association between mental and neurological disorders, both pre-existing and subsequent, and the risk of susceptibility, severity and mortality of COVID-19. Methods In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, PsycINFO, and Cochrane library databases for studies published from the inception up to January 16, 2021 and updated at July 7, 2021. Observational studies including cohort and case-control, cross-sectional studies and case series that reported risk estimates of the association between mental or neurological disorders and COVID-19 susceptibility, illness severity and mortality were included. Two researchers independently extracted data and conducted the quality assessment. Based on I 2 heterogeneity, we used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (95% CI). Subgroup analyses and meta-regression analysis were also performed. This study was registered on PROSPERO (registration number: CRD 42021230832). Finding A total of 149 studies (227,351,954 participants, 89,235,737 COVID-19 patients) were included in this analysis, in which 27 reported morbidity (132,727,798), 56 reported illness severity (83,097,968) and 115 reported mortality (88,878,662). Overall, mental and neurological disorders were associated with a significant high risk of infection (pre-existing mental: OR 1·67, 95% CI 1·12-2·49; and pre-existing neurological: 2·05, 1·58-2·67), illness severity (mental: pre-existing, 1·40, 1·25-1·57; sequelae, 4·85, 2·53-9·32; neurological: pre-existing, 1·43, 1·09-1·88; sequelae, 2·17, 1·45-3·24), and mortality (mental: pre-existing, 1·47, 1·26-1·72; neurological: pre-existing, 2·08, 1·61-2·69; sequelae, 2·03, 1·66-2·49) from COVID-19. Subgroup analysis revealed that association with illness severity was stronger among younger COVID-19 patients, and those with subsequent mental disorders, living in low- and middle-income regions. Younger patients with mental and neurological disorders were associated with higher mortality than elders. For type-specific mental disorders, susceptibility to contracting COVID-19 was associated with pre-existing mood disorders, anxiety, and attention-deficit hyperactivity disorder (ADHD); illness severity was associated with both pre-existing and subsequent mood disorders as well as sleep disturbance; and mortality was associated with pre-existing schizophrenia. For neurological disorders, susceptibility was associated with pre-existing dementia; both severity and mortality were associated with subsequent delirium and altered mental status; besides, mortality was associated with pre-existing and subsequent dementia and multiple specific neurological diseases. Heterogeneities were su...

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Section: Resultsmentioning

confidence: 99%

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

Liu

Yan³

et al. 2021

EClinicalMedicine

Self Cite

102

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“…Although the questionnaire is helpful for epidemiological purposes to detect insomnia symptoms and evaluate their severity, it is not able to differentiate between primary and comorbid insomnia [ 26 ], nor can it be treated as a diagnosis. This is especially important due to the large battery of literature pointing to the pandemic’s influence on specific sleep disorders, such as obstructive sleep apnea [ 33 ] and circadian changes [ 34 ]. The ISI scores described in this study should therefore be treated as a reflection of the respondents’ subjective sleep difficulties and their severity, not as a diagnosis of a specific sleep disorder.…”

Section: Discussionmentioning

confidence: 99%

Sleepless in Solitude—Insomnia Symptoms Severity and Psychopathological Symptoms among University Students during the COVID-19 Pandemic in Poland

Fila-Witecka

Małecka

Senczyszyn

et al. 2022

IJERPH

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Since 25 March 2020, all schools, colleges, and universities in Poland have indefinitely closed and, where possible, have activated distance learning because of the COVID-19 pandemic. Considering that the undergraduate years are usually characterized by a high prevalence of emotional disorders and sleep problems, it can be expected that the current situation may have a remarkable impact on the student population. This study aimed to investigate the occurrence of sleep problems among Polish university students as well as the relationship of insomnia symptoms severity with psychopathological symptoms, posttraumatic stress disorder (PTSD) symptoms, and behavioral factors, such as substance use, changes in the amount of sleep, and the level of physical activity during the COVID-19 pandemic. Data were collected from 1111 Polish university students via an online survey conducted between IV and VI 2020. The survey included demographic variables, the level of psychopathological symptoms (General Health Questionnaire, GHQ-28), insomnia (Insomnia Severity Index, ISI), and symptoms of posttraumatic stress (Impact of Events Scale-Revised, IES-R). The results showed that over half of the studied group of students had some form of sleep disturbances during the period of data collection, with moderate-to-severe insomnia symptoms noted in 21.6%. At the same time, the majority of the sample declared they slept more during the pandemic. A significant positive correlation was observed between the severity of insomnia symptoms and PTSD symptoms, as well as GHQ scores, increased substance use, and decreased physical activity. An additional association between the presence of dreams related to the event and insomnia symptoms as well as GHQ scores has been found. The results suggest that sleep problems may be prevalent among university students during the pandemic. Moreover, although the symptoms of insomnia, as well as the severity of sleep disturbance, significantly correlated with all the investigated variables, the direction of those associations remains to be established.

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“…The high level of psychological distress in patients with chronic diseases has been explained by the anxiety arising from the fear of contagion, as this event may be particularly dangerous in this fragile population [ 27 ]. It is now acquired that patients with OSA are at high risk of developing severe COVID-19 [ 29 ]. Our data indicate that although a number of patients complained symptoms of anxiety and depression, still the proportion was similar to the control group, indicating that the emotional distress in these patients is not divergent from the general population.…”

Section: Discussionmentioning

confidence: 99%

Sleep quality and mental health during the COVID-19 pandemic in patients with severe obstructive sleep apnea

Spicuzza

Mancuso

Campisi

et al. 2022

J Patient Rep Outcomes

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Background The first wave of the COVID-19 pandemic has produced remarkable effects on the sleep quality and mental status of the general population and more dramatic effects on patients with chronic illness. Patients with obstructive sleep apnea (OSA), already suffering from disordered sleep, might be more susceptible to the effect of the pandemic on their sleep quality and mental health. We therefore performed a case–control study to compare sleep quality, depression and anxiety symptoms reported by patients with severe OSA and age-matched healthy subjects during the first wave of the COVID-19. In June–July 2020 we enrolled a total of 222 patients with severe OSA, all treated with continuous positive airway pressure, and 164 healthy controls. Self-reported sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI). Symptoms of depression were assessed using the Patient Health Questionnaire module 9 (PHQ-9), while the specific “Coronavirus Anxiety Scale” (CAS) evaluated the level of anxiety. Results Patients with OSA (61% males, 65 ± 9.6 years old, BMI 30.5 ± 3.6) and healthy controls had similar characteristics except for BMI slightly lower in controls. The perceived quality of sleep, referred to the pre-pandemic period, was significantly worse in patients with OSA than in controls. During the pandemic the rate of reported sleep disturbance increased from 54 to 66% in patients with OSA and from 29 to 40% in controls. A high percentage of patients and controls reported symptoms of depression (61% OSA and 65% controls), whereas lower levels of anxiety, similar in the two groups, were observed. In patients with OSA the PSQI score significantly positively correlated with the PHQ-9 score (r2 = 0.81) and the CAS score (r2 = 0.65). Conclusion The rate of reported sleep disturbance in patients with OSA during the first wave of the COVID-19 pandemic is one of the highest evidenced in literature so far. As for the general population, in these patients there is a strict link between the perceived sleep quality and the psychological distress caused by the pandemic. A further deterioration of sleep quality is a fearsome event in the life of these patients who face life-long sleep problems.

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

Cited by 39 publications

References 36 publications

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

Mental and neurological disorders and risk of COVID-19 susceptibility, illness severity and mortality: A systematic review, meta-analysis and call for action

Sleepless in Solitude—Insomnia Symptoms Severity and Psychopathological Symptoms among University Students during the COVID-19 Pandemic in Poland

Sleep quality and mental health during the COVID-19 pandemic in patients with severe obstructive sleep apnea

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