Download PDF
CC BY-NC-ND 4.0 · Sleep Sci
DOI: 10.1055/s-0044-1782166
Short Communication

Is Obstructive Sleep Apnea Associated with Higher Covid-19 Severity?

Laíla Cândida Zacarias 
1   Graduate Program in Cardiovascular Sciences, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Danielle Mesquita Torres
2   Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
,
Samir Câmara Magalhães
2   Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
3   Faculty of Medicine, Universidade de Fortaleza, Fortaleza, CE, Brazil
,
Manoel Alves Sobreira-Neto
4   Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
,
Camila Ferreira Leite
1   Graduate Program in Cardiovascular Sciences, Universidade Federal do Ceará, Fortaleza, CE, Brazil
5   Masters Program in Physiotherapy and Functioning, Universidade Federal do Ceará, Fortaleza, CE, Brazil
› Author Affiliations Funding Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Funding Code 001.
› Further Information
   Permissions and Reprints

Abstract

Objective To investigate the associations between obstructive sleep apnea (OSA) and coronavirus disease 2019 (COVID-19) severity.

Methods Twelve individuals hospitalized in a Brazilian tertiary hospital diagnosed with COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) underwent respiratory polygraphy.

Results Polygraphic records identified seven participants without obstructive sleep apnea (OSA) (OSA-) and five with OSA (OSA + ). The OSA+ group presented worse peripheral oxygen saturation (77.6% ± 7.89%) than the OSA- group (84.4% ± 2.57%) (p = 0.041). Additionally, the OSA+ group showed greater COVID-19 severity (100%) than the OSA- group (28.57%) (p = 0.013) and required longer oxygen therapy (p = 0.038), but without difference in the length of hospitalization. The OSA+ group also presented higher rates of platelets (p = 0.008) and D-dimer (1,443 ± 897) than the OSA- group (648 ± 263 ng/mL) (p = 0.019).

Conclusion Obstructive sleep apnea in individuals hospitalized due to COVID-19 was associated with higher COVID-19 severity, worse peripheral oxygen saturation, longer oxygen therapy time, and higher platelet and D-dimer rates.

Keywords

COVID-19 - obstructive sleep apnea - sleep - polygraphy

Authors' Contribution

LCZ: Preparation and planning of work, data acquisition, and manuscript drafting.


DMT: Data acquisition, data analysis, and interpretation.


SCM, MASN: revised the work critically for important intellectual content.


CFL: drafted and made substantial contributions to the conception of the work and revised it critically.




Publication History

Received: 21 June 2023

Accepted: 05 October 2023

Article published online:
10 May 2024

© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Patel U, Malik P, Usman MS. et al. Age-adjusted risk factors associated with mortality and mechanical ventilation utilization amongst COVID-19 hospitalizations—a systematic review and meta-analysis. SN Compr Clin Med 2020; 2 (10) 1740-1749
    CrossrefPubMedGoogle Scholar
  • 2 Seidu S, Gillies C, Zaccardi F. et al. The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis. Endocrinol Diabetes Metab 2020; 4 (01) e00176
    CrossrefPubMedGoogle Scholar
  • 3 Cai Q, Chen F, Wang T. et al. Obesity and COVID-19 severity in a designated hospital in Shenzhen, China. Diabetes Care 2020; 43 (07) 1392-1398
    CrossrefPubMedGoogle Scholar
  • 4 Memtsoudis S, Liu SS, Ma Y. et al. Perioperative pulmonary outcomes in patients with sleep apnea after noncardiac surgery. Anesth Analg 2011; 112 (01) 113-121
    CrossrefPubMedGoogle Scholar
  • 5 Pazarlı AC, Ekiz T, İlik F. Coronavirus disease 2019 and obstructive sleep apnea syndrome. Sleep Breath 2021; 25 (01) 371
    CrossrefPubMedGoogle Scholar
  • 6 Tufik S. Obstructive Sleep Apnea as a comorbidity to Covid-19. Sleep Sci 2020; 13 (03) 181-182
    PubMedGoogle Scholar
  • 7 Chan MTV, Wang CY, Seet E. et al; Postoperative Vascular Complications in Unrecognized Obstructive Sleep Apnea (POSA) Study Investigators. Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA 2019; 321 (18) 1788-1798
    CrossrefPubMedGoogle Scholar
  • 8 Rouatbi S, Ghannouchi I, Kammoun R, Ben Saad H. The ventilatory and diffusion dysfunctions in obese patients with and without obstructive sleep apnea-hypopnea syndrome. J Obes 2020; 2020: 8075482
    CrossrefPubMedGoogle Scholar
  • 9 South AM, Diz DI, Chappell MC. COVID-19, ACE2, and the cardiovascular consequences. Am J Physiol Heart Circ Physiol 2020; 318 (05) H1084-H1090
    CrossrefPubMedGoogle Scholar
  • 10 Barceló A, Elorza MA, Barbé F, Santos C, Mayoralas LR, Agusti AG. Angiotensin converting enzyme in patients with sleep apnoea syndrome: plasma activity and gene polymorphisms. Eur Respir J 2001; 17 (04) 728-732
    CrossrefPubMedGoogle Scholar
  • 11 World Medical Association.. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 2001; 79 (04) 373-374
    PubMedGoogle Scholar
  • 12 Yan X, Han X, Peng D. et al. Clinical characteristics and prognosis of 218 patients with COVID-19: a retrospective study based on clinical classification. Front Med (Lausanne) 2020; 7: 485
    CrossrefPubMedGoogle Scholar
  • 13 Berry RB, Brooks R, Gamaldo CE. et al. The AASM manual for the scoring of sleep and associated events. Rules, Terminology and Technical Specifications, Darien, Illinois. American Academy of Sleep Medicine 2012; 176: 2012
    Google Scholar
  • 14 Mashaqi S, Lee-Iannotti J, Rangan P. et al. Obstructive sleep apnea and COVID-19 clinical outcomes during hospitalization: a cohort study. J Clin Sleep Med 2021; 17 (11) 2197-2204
    CrossrefPubMedGoogle Scholar
  • 15 Cade BE, Dashti HS, Hassan SM, Redline S, Karlson EW. Sleep apnea and COVID-19 mortality and hospitalization. Am J Respir Crit Care Med 2020; 202 (10) 1462-1464
    CrossrefPubMedGoogle Scholar
  • 16 Kushida CA, Chediak A, Berry RB. et al; Positive Airway Pressure Titration Task Force, American Academy of Sleep Medicine. Clinical guidelines for the manual titration of positive airway pressure in patients with obstructive sleep apnea. J Clin Sleep Med 2008; 4 (02) 157-171
    CrossrefPubMedGoogle Scholar
  • 17 Singer M, Young PJ, Laffey JG. et al. Dangers of hyperoxia. Crit Care 2021; 25 (01) 440
    CrossrefPubMedGoogle Scholar
  • 18 Tufik S, Gozal D, Ishikura IA, Pires GN, Andersen ML. Does obstructive sleep apnea lead to increased risk of COVID-19 infection and severity?. J Clin Sleep Med 2020; 16 (08) 1425-1426
    CrossrefPubMedGoogle Scholar
  • 19 Su VY-F, Liu C-J, Wang H-K. et al. Sleep apnea and risk of pneumonia: a nationwide population-based study. CMAJ 2014; 186 (06) 415-421
    CrossrefPubMedGoogle Scholar
  • 20 Memtsoudis SG, Ivascu NS, Pryor KO, Goldstein PA. Obesity as a risk factor for poor outcome in COVID-19-induced lung injury: the potential role of undiagnosed obstructive sleep apnoea. Br J Anaesth 2020; 125 (02) e262-e263
    CrossrefPubMedGoogle Scholar
  • 21 Rico-Rosillo MG, Vega-Robledo GB. [Sleep and immune system]. Alergia 2018; 65 (02) 160-170
    PubMedGoogle Scholar