Undiagnosed obstructive sleep apnea syndrome as a treatable cause of new‐onset sleepiness in some post‐COVID patients

Abstract

Background and purposeInfection with COVID‐19 can lead to persistent sequelae, such as fatigue, daytime sleepiness or disturbed sleep, that can remain for more than 12 weeks and that are summarized as post‐COVID syndrome. The causes remain unclear. The present study investigated the presence of sleep disorders in patients with post‐COVID syndrome using polysomnography.MethodsThirty‐four patients with post‐COVID syndrome and new‐onset fatigue and sleepiness after a SARS‐CoV2 infection underwent polysomnography in accordance with American Association of Sleep Medicine (AASM) standards as part of their clinical workup. Analysis was performed visually based on AASM criteria (scoring manual version 2.6, 2020).ResultsPolysomnography revealed a sleep efficiency of <80% in 50% of patients and a mean respiratory disturbance index (RDI) of 9.9 ± 15.4/h. Excluding central apneas, 12 patients (35%) had an RDI of ≥5/h, pointing to obstructive sleep apnea syndrome (OSAS; AASM 2014). Patients with a high RDI were significantly older (p = 0.01) and showed a trend towards a higher body mass index (p = 0.08) than patients with a normal RDI but had no other risk factors for OSAS. Six patients agreed to long‐term treatment of their OSAS and all reported discontinuation of daytime symptoms.ConclusionsPost‐COVID symptoms such as daytime sleepiness, fatigue and memory and concentration problems may in part be a result of reduced sleep efficiency and sleep apnea in a relevant percentage of patients. This possibly treatable cause of the symptoms should be kept in mind in patients presenting with post‐COVID syndrome.

Long COVID—ACOEM Guidance Statement

“…Workers with fatigue should be evaluated with a thorough history, physical examination, and appropriate laboratory tests to determine whether there are other or additional causes of fatigue besides long COVID, including depression or sleep apnea. 69 As people may not be familiar with ME/CFS diagnostic criteria, some people who believe they have ME/CFS may not meet criteria, while others who do not recognize that they meet criteria may not be aware of the diagnosis. 70 Whether a worker meets criteria, it is important to determine whether they have exertional intolerance and postexertional malaise because this may affect performance and recommendations for rehabilitation.…”

“…Occupational medicine physicians may be asked to evaluate workers with fatigue after acute COVID-19 to assess their ability to work or recommend accommodations. Workers with fatigue should be evaluated with a thorough history, physical examination, and appropriate laboratory tests to determine whether there are other or additional causes of fatigue besides long COVID, including depression or sleep apnea 69 . As people may not be familiar with ME/CFS diagnostic criteria, some people who believe they have ME/CFS may not meet criteria, while others who do not recognize that they meet criteria may not be aware of the diagnosis 70 .…”

Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review

“…Persistent fatigue, lack of energy, cognitive disturbances, and mental disorders are common in both conditions [ 58 , 59 , 60 , 61 , 62 , 63 , 64 ]. While it is unclear to what extent OSA contributes to the symptoms of long COVID, data suggest that treating previously undiagnosed OSA in patients with long COVID may lead to the resolution of symptoms in some patients [ 65 ]. Cardiovascular complications are also a concern, as long COVID’s association with symptoms like palpitations and chest pain [ 59 ] could heighten the already increased risk of cardiac complications among OSA patients [ 66 ].…”