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. 2023 Jul 1;19(7):1303-1311.
doi: 10.5664/jcsm.10588.

Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults

Stuart F Quan  1   2 , Matthew D Weaver  1   2 , Mark É Czeisler  3   4   5 , Laura K Barger  1   2 , Lauren A Booker  5   6 , Mark E Howard  5   7   8 , Melinda L Jackson  4   5 , Rashon Lane  1 , Christine F McDonald  5   8   9   10 , Anna Ridgers  5   8   9 , Rebecca Robbins  1   2 , Prerna Varma  4 , Shantha M W Rajaratnam  1   2   4   5 , Charles A Czeisler  1   2
Affiliations

Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults

Stuart F Quan et al. J Clin Sleep Med. .

Abstract

Study objectives: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination?

Methods: This was a cross-sectional survey of a diverse sample of 15,057 US adults.

Results: COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized.

Conclusions: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization.

Citation: Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.

Keywords: COVID-19; epidemiology; hospitalization; infection; obstructive sleep apnea.

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Conflict of interest statement

All authors have seen and approved the manuscript. This work was supported by the Centers for Disease Control and Prevention. Dr. M. Czeisler was supported by an Australian-American Fulbright Fellowship, with funding from The Kinghorn Foundation. The salary of Drs. Barger, Czeisler, Robbins, and Weaver were supported, in part, by NIOSH R01 OH011773 and NHLBI R56 HL151637. Dr. Robbins also was supported in part by NHLBI K01 HL150339. MDW reported consulting fees from Fred Hutchinson Cancer Center, the National Sleep Foundation, and the University of Pittsburgh. M.E.C. reported personal fees from Vanda Pharmaceuticals Inc. and research grants or gifts to Monash University from WHOOP, Inc., Hopelab, Inc., CDC Foundation, and the Centers for Disease Control and Prevention. C.A.C. reported receiving grants and personal fees from Teva Pharma Australia, receiving grants from the National Institute of Occupational Safety and Health R01-OH-011773, personal fees from and equity interest in Vanda Pharmaceuticals Inc., educational and research support from Philips Respironics Inc., an endowed professorship provided to Harvard Medical School from Cephalon, Inc., an institutional gift from Alexandra Drane, and a patent on Actiwatch-2 and Actiwatch-Spectrum devices with royalties paid from Philips Respironics Inc. C.A.C.’s interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. C.A.C. also served as a voluntary board member for the Institute for Experimental Psychiatry Research Foundation, Inc. S.M.W.R. reported receiving grants and personal fees from Cooperative Research Centre for Alertness, Safety, and Productivity and receiving grants and institutional consultancy fees from Teva Pharma Australia and institutional consultancy fees from Vanda Pharmaceuticals, Circadian Therapeutics, BHP Billiton, and Herbert Smith Freehills. S.F.Q. has served as a consultant for Best Doctors, Bryte Foundation, Jazz Pharmaceuticals, and Whispersom. R.R. reports personal fees from SleepCycle AB; Rituals Cosmetics BV; Denihan Hospitality Group, LLC; AdventHealth; and With Deep, LLC. A preliminary version of this manuscript is available as a non-peer-reviewed preprint (doi:10.20944/preprints202209.0383.v1).

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