Sleep Apnea an Unrecognized Risk Factor for Mortality in Patients with COVID-19

by Linda Kossoff •

Is sleep apnea an unrecognized risk factor for COVID-19-related death, hospitalization, ventilator use, and intensive care unit (ICU) admission among patients with positive COVID-19 testing?

BOTTOM LINE

In this analysis, sleep apnea is an identified risk factor for COVID-19 mortality, highlighting the need for close monitoring of patients with sleep apnea who become infected.

BACKGROUND: A report on 5,700 patients with COVID-19 identifies older age, minority ethnicity, obesity, hypertension, and diabetes as common risk factors for poor outcomes from the infection; however, sleep apnea, prevalent in older, obese, and minority individuals, has not been identified as a common risk factor for mortality and hospitalizations in patients with COVID-19.

STUDY DESIGN: Case control study.

COMMENT: This is a correspondence, but it discusses the role that obstructive sleep apnea (OSA) may play in increasing mortality and hospitalization in COVID-19 infection. There was a significant association between history of OSA and CPAP usage with death from COVID-19. This seems important because of the independent risk factor of adults on CPAP and the risk of death associated with COVID-19 infection and the non-obvious mechanisms that they discuss. —Eric Gantwerker, MD

SETTING: Harvard Medical School, Boston.

SYNOPSIS: To explore whether sleep apnea is an unrecognized risk factor for poor outcomes from COVID-19, researchers analyzed electronic health record data on 4,668 COVID-19-positive patients (55.6% female, median age 56.1 years, body mass index 28.8) from a large U.S.-based healthcare system. The sample was composed of 48.3% European Americans, 14.8% African Americans, 14.0% Hispanic and Latino Americans, and 22.9% others. Outcomes were based on a median of 31 days of follow-up. The overall mortality rate was 7.4%; however, the 443 participants (9.5%) with sleep apnea had an increased all-cause mortality rate (11.7%) compared with sleep apnea control participants (6.9%). Although this association between sleep apnea and COVID-19 death was somewhat reduced after adjusting for BMI—a common comorbidity of sleep apnea—it persisted in analyses adjusted for demographics. Authors state that these results highlight the importance of improved efforts to recognize sleep apnea in individuals presenting with COVID-19 and point to the need to research the underlying biological plausibility of pathways linking sleep apnea to COVID-19-related mortality. Study limitations included a lack of adherence data, suggesting a need for replication in a larger study.

CITATION: Cade BE, Dashti HS, Hassan SM, et al. Sleep apnea and COVID-19 mortality and hospitalization. Am J Respir Crit Care Med. 2020;202:1462-1464.