Obstructive sleep apnea heightens risk for COVID-19, severe complications
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Adults with obstructive sleep apnea faced elevated risks for developing COVID-19 and experiencing COVID-19-related complications, according to study results published in Thorax.
Further, having comorbid airways disease in addition to OSA further raised the risk for outcomes related to COVID-19, according to researchers.
“These findings support consideration of sleep apnea as a high-risk condition for adverse COVID-19 outcomes and warrant higher prioritization of OSA patients for public health protections such as vaccination, especially in individuals with underlying airways diseases,” Tetyana Kendzerska, MD, PhD, assistant professor of medicine at the University of Ottawa, and Sachin R. Pendharkar, MD, associate professor of medicine and community health sciences at the University of Calgary, told Healio in a statement. “Many sleep clinics and laboratories reduced service capacity during the pandemic; these findings suggest that diagnosis and treatment of sleep apnea should be prioritized rather than halted during periods of high COVID-19 in the community to reduce this risk.”
In a retrospective population-based cohort study, Kendzerska, Pendharkar and colleagues analyzed 324,029 patients (median age, 58 years; 65% men) with OSA receiving positive airway pressure therapy 5 years before the pandemic and 4,588,200 individuals (median age, 47 years; 52% men) from the general population without OSA to determine the link between OSA and a COVID-19 infection or several COVID-19-related complications, including COVID-19-related ED visits, hospitalizations, ICU admissions and death, within 1 year of the pandemic onset.
Researchers also investigated whether comorbid cardiometabolic conditions or chronic airways disease heightened the risk for COVID-19-related outcomes in patients with OSA.
Researchers used inverse probability of treatment weighting to balance baseline characteristics of individuals in the groups and to lessen the impact of confounding variables.
In the primary analysis, weighted hazard ratios showed patients with OSA had greater risks for a positive COVID-19 test (HR = 1.17; 95% CI, 1.13-1.21) and COVID-19-related ED visits (HR = 1.62; 95% CI, 1.51-1.73), hospitalizations (HR = 1.5; 95% CI, 1.37-1.65) and ICU admissions (HR = 1.53; 95% CI, 1.27-1.84) than those without OSA. The only factor that these patients did not have a greater risk for was COVID-19-related mortality within 30 days (HR = 0.98; 95% CI, 0.82-1.16).
These risks persisted when researchers evaluated patients with moderate/severe OSA (n = 191,447; median age, 57 years; 68% men) against those without OSA.
The greater hazards related to COVID-19 for patients with OSA were not surprising due to plausible pathophysiologic mechanisms, according to Kendzerska and Pendharkar; however, their research adds more detailed evidence to what is already known.
“Most published studies are limited by focusing on the early stages of the pandemic, a relatively small number of individuals with sleep apnea and less-robust methods for identifying individuals with sleep apnea or COVID-19 infection without adjustment for covariates,” they told Healio. “Our study enhances published evidence by incorporating the entire first year of the COVID-19 pandemic with a large number of events, propensity score weighting to properly adjust for confounders and validated definitions for OSA in health administrative data.”
Researchers further observed that compared with the control group, those with OSA and comorbid airways disease faced greater risks for a positive COVID-19 test (HR = 1.34; 95% CI, 1.25-1.44) and COVID-19-related ED visits (HR = 1.89; 95% CI, 1.62-2.21), hospitalizations (HR = 1.99; 95% CI, 1.67-2.37), ICU admissions (HR = 1.85; 95% CI, 1.31-2.62) and mortality (HR = 1.37; 95% CI, 1.04-1.82).
Conversely, researchers found lower hazard ratios for COVID-19 complications among patients with OSA and comorbid cardiometabolic conditions than among patients without cardiometabolic conditions. One of the potential explanations for this finding, the researchers said, is that due to the significant effect of cardiometabolic diseases on COVID-19-related outcomes, the contribution of OSA became smaller but remained significant.
“Future studies are required to assess putative mechanisms via which the pathophysiology of OSA, alone and in combination with lung and cardiometabolic conditions, may interact with COVID-19, and the effect of using OSA therapies on COVID-19-related outcomes,” Kendzerska and Pendharkar told Healio. “Our study used health administrative data with no information available to understand physiological mechanisms. In addition, our study was limited by a lack of information on positive airway pressure therapy use to assess the effect of treatment.”
For more information:
Tetyana Kendzerska, MD, PhD, can be reached at tkendzerska@toh.ca.
Sachin R. Pendharkar, MD, can be reached at sachin.pendharkar@ucalgary.ca.