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[Preprint]. 2024 Aug 16:2024.08.15.24312067.
doi: 10.1101/2024.08.15.24312067.

Obstructive Sleep Apnea is a Risk Factor for Incident COVID-19 Infection

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 , Christine F McDonald  5   8   9   10 , Anna Ridgers  5   9   8 , Rebecca Robbins  1   2 , Prerna Varma  4 , Shantha M W Rajaratnam  1   4   5   2 , Charles A Czeisler  1   2
Affiliations

Obstructive Sleep Apnea is a Risk Factor for Incident COVID-19 Infection

Stuart F Quan et al. medRxiv. .

Update in

Abstract

Cross-sectional studies suggest that obstructive sleep apnea (OSA) is a potential risk factor for incident COVID-19 infection, but longitudinal studies are lacking. In this study, two surveys from a large general population cohort, the COVID-19 Outbreak Public Evaluation (COPE) Initiative, undertaken 147 ± 58 days apart were analyzed to determine whether the pre-existing OSA was a risk factor for the incidence of COVID-19. Of the 24,803 respondents completing the initial survey, 14,950 were negative for COVID-19; data from the follow-up survey were available for 2,325 respondents. Those with incident COVID-19 infection had a slightly higher prevalence of OSA (14.3 vs. 11.5%, p=0.068). Stratification by treatment status revealed that those untreated for their OSA were at greater risk for developing COVID-19 infection (OSA Untreated, 14.2 vs. 7.4%, p≤0.05). In a logistic regression model adjusted for comorbidities, demographic and socioeconomic factors and the interaction between vaccination status and OSA, incident COVID-19 infection was 2.15 times more likely in those with untreated OSA (aOR: 2.15, 95% CI: 1.18-3.92, p≤0.05). Stratification by treatment status revealed only untreated OSA participants were at greater risk for COVID-19 (aOR: 3.21, 95% CI: 1.25-8.23, p≤0.05). The evidence from this study confirms untreated OSA as a risk factor for acquiring COVID-19 infection and highlights the importance of actively treating and managing OSA as a preventative mechanism against COVID-19 disease.

Keywords: COVID-19; Obstructive Sleep Apnea; SARS-CoV-2 infection.

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Conflict of interest statement

MDW reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, and Delta Airlines; as well as consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. LKB reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as honorariums from the National Institutes of Occupational Safety and Health, University of Arizona and University of British Columbia. MÉC reported personal fees from Vanda Pharmaceuticals Inc., research grants or gifts to Monash University from WHOOP, Inc., Hopelab, Inc., CDC Foundation, and the Centers for Disease Control and Prevention. SMWR reported receiving grants and personal fees from Cooperative Research Centre for Alertness, Safety, and Productivity, 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. SFQ has served as a consultant for Teledoc, Bryte Foundation, Jazz Pharmaceuticals, Summus, Apnimed, and Whispersom. RR reports personal fees from SleepCycle AB; Rituals Cosmetics BV; Sonesta Hotels International, LLC; Ouraring Ltd; AdventHealth; and With Deep, LLC. CAC serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc. and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc., Optum, and ResMed, Inc.; research support to Brigham and Women’s Hospital from Axome Therapeutics, Inc., Dayzz Ltd., Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc., Takeda Pharmaceutical Co., LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc., Teva Pharmaceuticals Industries, Ltd., and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axome, Inc., Bryte Foundation, With Deep, Inc. and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd. and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. CAC has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc.; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc./Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc.; Puget Sound Pilots; and the San Francisco Sheriff’s Department; Schlumberger Technology Corp.; Union Pacific Railroad; United Parcel Service; Vanda Pharmaceuticals. CAC has received travel support from the Stanley Ho Medical Development Foundation for travel to Macao and Hong Kong; equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc.; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc., Harmony Biosciences LLC, Eisai Co., LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp., Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F. and Diana L. Quan Charitable Fund. Dr Czeisler’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of interest policies. No other disclosures were reported.

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