Coronavirus disease 2019 (COVID-19) patients with modified high-risk obstructive sleep apnea (mHR-OSA) had poorer clinical outcomes than those with modified low-risk obstructive sleep apnea (mLR-OSA) independent of age, sex and comorbidities, according to a study published in Annals of the American Thoracic Society.
“To our best knowledge, there were no prospective reports published about the recovery rate of COVID-19 cases with concomitant obstructive sleep apnea (OSA) at the time of the planning of our study, and we hypothesised that the clinical improvement rate would be lower among the OSA patients given the potential pathophysiological mechanisms involved in sleep-related breathing disorders,” wrote Yüksel Peker, Koc University Research Center for Translational Medicine, Istanbul, Turkey, and colleagues.
The prospective observational study, conducted in three hospitals in Istanbul from March 10 to June 22, 2020, included 320 patients with a median age of 53.2 years diagnosed with COVID-19. More than half of the patients were male. Patients were categorised as high-risk or low-risk OSA according to the Berlin questionnaire that was administered in outpatient clinic or in-hospital or shortly after discharge from hospital. Meanwhile, an mHR-OSA score based on the snoring patterns (intensity and/or frequency), breathing pauses and morning/daytime sleepiness, without taking obesity and hypertension into account, were used in the regression models.
The primary outcome was clinical improvement defined as a decline of 2 categories from admission on a 7-category ordinal scale while secondary outcomes included clinical worsening (increase of 1 category), need for hospitalisation, supplemental oxygen and intensive care.
Overall, 121 (37.8%) patients were categorised as known OSA (n=3) or high-risk OSA (n=118), while 199 (62.2%) patients were categorised as low-risk OSA. According to the modified scoring, 70 (21.9%) patients had mHR-OSA.
Among 242 patients requiring hospitalisation, occurence of clinical improvement within 2 weeks was lower among patients in the mHR-OSA group than the mLR-OSA group (75.4% vs 88.4%, P = 0.014). In multivariate regression analyses, mHR-OSA (adjusted odds ratio [OR] 0.42; 95% confidence interval [CI] 0.19-0.92) and male sex (OR 0.39, 95% CI 0.17-0.86) predicted a delayed clinical improvement.
In the entire study population (n=320), including non-hospitalised patients, mHR-OSA was associated with clinical worsening (adjusted hazard ratio 1.55, 95% CI 1-00-2.39, P = 0.048). Additionally, mHR-OSA predicted the need for supplemental oxygen (OR 1.95, 95% CI 1.06-3.59, P = 0.032) in the multivariate logistic regression analysis.
“Our results indicate that COVID-19 patients with mHR-OSA are at increased risk for delayed clinical improvement, clinical worsening and need for supplemental oxygen compared to those with mLR-OSA,” the authors noted. “The COVID-19 pandemic is now globally urging the need for new approaches beyond the polysomnography requirement for the management of OSA cases.”
“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,” the authors added.