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Observational Study
. 2022 Sep;26(3):1399-1407.
doi: 10.1007/s11325-021-02476-z. Epub 2021 Sep 24.

Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19

S F J Voncken #  1 , T M H Feron #  1 , S A J S Laven #  1 , U Karaca  1 , K Beerhorst  2 , P Klarenbeek  2 , J M J A A Straetmans  3 , G J de Vries  1 , A A B Kolfoort-Otte  1 , M D de Kruif  4
Affiliations
Observational Study

Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19

S F J Voncken et al. Sleep Breath. 2022 Sep.

Abstract

Purpose: Data from large patient registry studies suggested an increased incidence and increased mortality in coronavirus disease-2019 (COVID-19) in patients with a history of obstructive sleep apnea (OSA). This study aimed to compare the prevalence of OSA in patients with and without COVID-19 among patients admitted to the same hospital in the same time period. In addition, the impact of OSA on clinical outcomes of COVID-19 infection was investigated.

Methods: Observational cohort study. Clinical data were collected retrospectively from the complete medical records for each patient individually from March 1st 2020 to May 16th 2020.

Results: A total of 723 patients were diagnosed with COVID-19 and 1161 with non-COVID-19 disease. The prevalence of OSA did not differ between these groups (n = 49; 6.8% versus n = 66; 5.7%; p = 0.230). In patients with COVID-19, mortality was increased in the group of 49 patients with OSA (n = 17; 34.7%) compared to 674 COVID-19 patients without OSA (n = 143; 21.2%; p = 0.028). This increased risk of mortality in COVID-19 patients with OSA (OR = 2.590; 95%CI 1.218-5.507) was independent from Body Mass Index (BMI), male gender, age, diabetes, cardiovascular disease, and obstructive lung disease. Presence of OSA in COVID-19 disease was further associated with an increased length of hospital stay (12.6 ± 15.7 days versus 9.6 ± 9.9 days; p = 0.049).

Conclusion: The prevalence of OSA did not differ between patients with or without COVID-19, but mortality and hospital length of stay were increased in patients with OSA and comorbid COVID-19. Hence, OSA should be included in COVID-19 risk factor analyses, Clinicians should be aware of the association and the mechanism should be further explored.

Keywords: COVID-19; Mortality; Obstructive sleep apnea; Risk factor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart patients were admitted to the hospital with a suspicion of Coronavirus disease 2019 (COVID-19). ED = emergency department. OSA = obstructive sleep apnea
Fig. 2
Fig. 2
Coronavirus disease 2019 (COVID-19) disease outcomes. Overview of disease severity, based on mortality, admission to ICU, total hospital stay, and hospital stay > 1 week in COVID-19 patients with OSA compared to COVID-19 patients without OSA. ICU = intensive care unit. OSA = obstructive sleep apnea. * = statistically significant difference. 1 = hospital stay more than one week (> 7 days). NS = not statistically significant
Fig. 3
Fig. 3
Risk factor analysis of coronavirus disease 2019 (COVID-19) for clinical outcomes. OR = odds ratio. CI = confidence interval. BMI = Body Mass Index. OSA = obstructive sleep apnea
Fig. 4
Fig. 4
Mortality and OSA per BMI class in hospitalized patients with COVID-19. BMI = Body Mass Index. OSA = obstructive sleep apnea. NS = non significant
See this image and copyright information in PMC

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