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Observational Study
. 2024 Mar;28(1):79-86.
doi: 10.1007/s11325-023-02855-8. Epub 2023 Jul 7.

Association between undiagnosed obstructive sleep apnea and severe course of COVID-19: a prospective observational study

Natalia Celejewska-Wójcik  1   2 , Kamil Polok  3   4 , Karolina Górka  3   5 , Tomasz Stachura  3   5 , Aleksander Kania  3   5 , Paweł Nastałek  3   5 , Sabina Lichołai  6 , Weronika Zastrzeżyńska  3   5 , Marek Przybyszowski  3   5 , Krzysztof Sładek  3   5
Affiliations
Observational Study

Association between undiagnosed obstructive sleep apnea and severe course of COVID-19: a prospective observational study

Natalia Celejewska-Wójcik et al. Sleep Breath. 2024 Mar.

Abstract

Purpose: Obstructive sleep apnea (OSA) is associated with many long-term health consequences. We hypothesized that previously unrecognized and untreated OSA may be associated with more severe respiratory failure in hospitalized patients with COVID-19.

Methods: Patients hospitalized in the Pulmonology Department with confirmed COVID-19, University Hospital in Kraków, Poland, between September 2020 and April 2021 were enrolled. OSA screening questionnaires including Epworth Sleepiness Scale (ESS), STOP-BANG, Berlin questionaire (BQ), OSA-50, and No-SAS were completed. Polygraphy was performed after > 24 h without requirement for supplemental oxygen.

Results: Of 125 patients with median age of 61.0 years, 71% of whom were male. OSA was diagnosed in 103 patients (82%) and was categorized as mild, moderate, and severe in 41 (33%), 30 (24%), and 32 (26%), respectively. Advanced respiratory support was introduced in 85 patients (68%), and 8 (7%) patients eventually required intubation. Multivariable analysis revealed that increased risk of requirement for advanced respiratory support was associated with higher respiratory event index (OR 1.03, 95%CI 1.00 to 1.07), oxygen desaturation index (OR 1.05, 95%CI 1.02 to 1.10), and hypoxic burden (1.02 95% CI 1.00 to 1.03) and lower minimal SpO2 (OR 0.89, 95%CI 0.81 to 0.98), but not with results of OSA screening tools like BQ score (OR 0.66, 95%CI 0.38 to 1.16), STOP-BANG score (OR 0.73, 95%CI 0.51 to 1.01), NoSAS score (OR 1.01, 95%CI 0.87 to 1.18), or OSA50 score (OR 0.84, 95%CI 0.70 to 1.01).

Conclusion: Previously undiagnosed OSA was common among hospitalized patients who survived the acute phase of COVID-19. The degree of OSA was associated with the severity of respiratory failure.

Keywords: COVID-19; Non-invasive ventilation; Obstructive sleep apnea; Respiratory failure.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Summary of the multivariable analysis. Abbreviations: HB, hypoxic burden, ODI, oxygen desaturation index; REI, respiratory event index; ESS, Epworth Sleepiness Scale
See this image and copyright information in PMC

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