Clinical outcomes poor in patients with high-risk sleep apnea, COVID-19

Patients with high-risk obstructive sleep apnea and COVID-19 may be at increased risk for delayed improvement, clinical worsening and need for supplemental oxygen compared with patients with low-risk OSA, researchers reported.

The multicenter, prospective, observational cohort OSACOVID-19 study included 320 patients (median age, 53.2 years; 45.9% women) with confirmed COVID-19 at three hospitals in Istanbul from March to June 2020. The Berlin questionnaire was used to determine whether patients had high-risk OSA or low-risk OSA. Researchers collected data on modified high-risk OSA scores based on snoring patterns, breathing pauses and morning/daytime sleepiness.

The primary outcome was clinical improvement, which was defined as a decline of two categories on a seven-category scale, ranging from discharged with normal activity to death on days 7, 14, 21 and 28. Secondary outcomes included clinical worsening, hospitalization, supplemental oxygen and intensive care.

Based on the Berlin questionnaire, 121 patients (37.8%) were categorized as having known (n = 3) or high-risk OSA (n = 118), and, of those, 70 (21.9%) had modified high-risk OSA.

Two hundred forty-two patients required hospitalization. Clinical improvement within 2 weeks was observed in 75.4% of patients with modified high-risk OSA compared with 88.4% of patients with modified low-risk OSA (P = .014).

Modified high-risk OSA was associated with clinical worsening (adjusted HR = 1.55; 95% CI, 1-2.39) and need for supplemental oxygen (OR = 1.95; 95% CI, 1.06-3.59) in the overall cohort, including patients hospitalized and not hospitalized.

Modified high-risk OSA (aOR = 0.42; 95% CI, 0.19-0.92) and male sex (OR = 0.39; 95% CI, 0.17-0.86) were predictors of delayed clinical improvement in multivariate regression analyses. Snoring patterns, especially louder snoring, predicted delayed clinical improvement, worsening, need for hospitalization, and need for supplemental oxygen and intensive care.

“The COVID-19 pandemic is now globally urging the need for new approaches beyond the polysomnography requirement for the management of OSA cases,” Yüksel Peker, MD, PhD, professor in the department of pulmonary medicine at Koç University School of Medicine at Koç University Hospital in Istanbul, and colleagues wrote in Annals of the American Thoracic Society. “The further follow-up of the current sample with clinical, laboratory and radiological investigations in addition to objective sleep recordings would provide further insights into the clinical usefulness of the modified Berlin questionnaire as a screening tool during the COVID-19 onset and into the association between OSA and long-term COVID-19 outcomes.”