Longer use of positive airway pressure may lower elevated COVID-19 risk in patients with sleep apnea

A new study found that obstructive sleep apnea is associated with increased risk for COVID-19 infection, and greater adherence to positive airway pressure therapy was associated with reduced risk for infection.

“We wanted to understand the relationship of obstructive sleep apnea and COVID-19 outcomes — specifically, whether sleep apnea would increase the risk of getting COVID-19, and increase the severity of COVID-19 once infected,” Dennis Hwang, MD, medical director of KP SBC Sleep Medicine at Kaiser Permanente and co-chair of sleep medicine at the Southern California Permanente Medical Group, told Healio. “We also wanted to understand the relationship between positive airway pressure therapy and COVID-19 outcomes — specifically, whether it would reduce the risk of infection and reduce the severity once infected.”

Researchers examined the Kaiser Permanente Southern California health care system database and reviewed medical records of 81,932 patients (mean age, 54 years; 60.2% men) at 10 sleep centers, of whom 68,492 had OSA. Data on daily positive airway pressure (PAP) therapy were also available, and the researchers assessed adherence from March to July 2020.

Patients with OSA were categorized based on PAP therapy use: less than 2 hours per day (n = 45,778), 2 to 3.9 hours per day (n = 4,898) or at least 4 hours per day (n = 17,816).

The primary outcomes were COVID-19 infection rates and severity, all-cause hospitalizations and ICU care or death.

Regardless of PAP therapy use less than 2 hours per day, 2 to 3.9 hours per day and at least 4 hours per day, patients with OSA were older (mean age, 54.5, 55.6 and 57.8 years, respectively vs. 47 years), more likely to be male (60.3%, 67.6% and 70.1%, respectively vs. 44%), more obese (mean BMI, 34.3, 35.2 and 35.8, respectively vs. 30.4) and had more Charlson comorbidities (2, 2.2 and 2.2, respectively vs. 1.3) and hypertension (12.4%, 13.8% and 13.8%, respectively vs. 5.6%) compared with patients without OSA.

Patients with OSA and the lowest use of PAP therapy had the highest rate of COVID-19 infection (2.1%). The rate of COVID-19 infection was lower with greater adherence to PAP therapy (1.7% for those with 2 to 3.9 hours of use; 1.3% for those with at least 4 hours of use). The rate of COVID-19 infection was 1.7% for patients in this study without OSA.

The researchers found no relationship between OSA and PAP therapy with the rate of hospitalization for COVID-19, need for ICU care or death.

In adjusted models, patients without OSA (OR = 0.83; 95% CI, 0.7-0.95) and those with OSA and PAP use of at least 4 hours per day (OR = 0.68; 95% CI, 0.59-0.79) had lower rates of COVID-19 infection compared with patients with OSA but poor PAP therapy use (OR = 0.82; 95% CI, 0.65-1.03), Hwang said during the presentation.

“We found that sleep apnea is associated with increased risk of COVID-19 infection and the risk increases when sleep apnea is more severe. We also found that PAP use is associated with reduced risk for COVID-19 infection, and the reduction is more prominent with greater use of PAP. These findings were significant even after adjusting for many baseline patient characteristics,” Hwang told Healio.

In addition, researchers found higher risk for COVID-19 infection among Black and Hispanic patients with OSA, and also lower adherence to PAP therapy.

“We believe that it is important to highlight these health care disparities and we need to be intentional about developing strategies to remove barriers and enhance care that is meaningful for all people,” he said.

Additional analyses are being performed to evaluate whether OSA and PAP therapy may relate to COVID-19 recovery, such as the risk for persistent symptoms, Hwang said.

“As a retrospective study, we are unable to definitively state that sleep apnea directly increases and PAP use directly reduces the risk for COVID-19 infection. However, the physiologic impact of both sleep apnea and COVID-19 on the respiratory system in body inflammation suggests that a direct influence is possible,” Hwang said. “We have used the results of this study to emphasize to our patients and to our community that if they have sleep apnea to be dedicated to using their PAP therapy. Good use may reduce the risk for COVID-19, in addition to reducing cardiovascular disease and improving sleep quality.”

References: