Sleep apnea may increase risk for long COVID

Key takeaways:

• After contracting SARS-CoV-2, adults with obstructive sleep apnea had up to a 75% increased risk for long COVID.
• Women with sleep apnea were more likely to develop long COVID than their male counterparts.

People with obstructive sleep apnea, particularly those with other chronic conditions, had a significantly increased risk for developing long COVID after a SARS-CoV-2 infection compared with those without obstructive sleep apnea, data show.

This finding was consistent across multiple research databases and definitions of long COVID, according to Hannah Mandel, a senior research scientist at NYU Langone Health, and colleagues.

“There’s still so much to uncover about long COVID, but this study will inform clinical care by identifying patients who should be watched more closely,” Mandel said in a press release. “People with sleep apnea who get infected with COVID should seek early treatment, pay attention to their symptoms and keep up with their vaccinations to lower the risk of infection in the first place.”

Previous research has shown that obstructive sleep apnea (OSA) may increase the risk for severe COVID-19 outcomes during the acute phase of infection.

As part of the NIH-funded RECOVER initiative, Mandel and colleagues assessed the impact of OSA on the risk for long COVID in adults and children using data from three electronic health record research networks: the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C), both of which enrolled adult patients only, as well as the pediatric-focused network PEDSnet.

All patients in the current analysis had tested positive for COVID-19 between March 2020 and February 2022. Of 333,642 adult patients in the PCORnet cohort, 5.1% had OSA and 16.6% had probable long COVID. Among approximately 1.7 million adult patients in the N3C cohort, 3.9% had OSA and 4.9% had probable long COVID. Finally, of 106,262 children in the PEDSnet cohort, 1.8% had OSA and 4.6% had probable long COVID.

Across the networks, the unadjusted OR for probable long COVID associated with an OSA diagnosis ranged from 1.41 to 3.93 in adults and children. In analyses adjusted for comorbidities, Mandel and colleagues reported that the association only remained significant for adults.

In the PCORnet cohort, a prior OSA diagnosis was associated with a 12% increased risk for long COVID compared with those without OSA, according to the release. In the N3C cohort, which included patients with higher levels of other chronic conditions vs. those in PCORnet, an OSA diagnosis was associated with a 75% increased risk for long COVID.

Mandel and colleagues also found that the risk for long COVID among patients with OSA was higher in women than men in the N3C cohort. Women with OSA had an 89% increased likelihood for developing long COVID, whereas men with OSA had a 59% increased likelihood.

The study was limited due to a lack of data on COVID-19 vaccination status and a lower prevalence of OSA compared with previous studies, according to the researchers.

“Nonetheless, these findings suggest that patients with OSA may be at elevated risk for PASC after SARS-CoV-2 and should be monitored for post-acute infection sequelae,” they concluded.

References:

• Mandel HL, et al. Sleep. 2023;doi:10.1093/sleep/zsad126.
• Sleep apnea associated with increased risk for long COVID. https://nyulangone.org/news/sleep-apnea-associated-increased-risk-long-covid. Published May 11, 2023. Accessed May 17, 2023.