Association between positive airway pressure treatment adherence and COVID-19 infection rates

A large retrospective study found a higher COVID-19 infection rate in patients with obstructive sleep apnoea (OSA) and lower positive airway pressure (PAP) treatment adherence. However, no association between sleep apnoea and its treatment was found with regard to the necessity of hospitalisation or the use of intensive care.

Within the USA, Kaiser Permanente is a very large non-profit healthcare plan with 12.5 million members that includes a network of sleep centres [1]. The study included 81,932 patients, all of them enrolled with Kaiser Permanente before February 2020 [1]. None of the patients had priors of COVID-19. “We specifically looked at adults and also those with daily PAP therapy data wirelessly transmitted, which we then used to calculate adherence between 1 March and 31 July 2020 coinciding with the pandemic period. We then assessed COVID-19 infection rates and measurements of COVID-19 severity,” explained Dr Dennis Hwang (Kaiser Permanente, CA, USA). The study population was sorted into 4 groups, based on PAP adherence:

• A: patients without OSA;
• B: OSA patients with PAP use ≤2 h/day;
• C: OSA patients with PAP use 2–3.9 h/day; and
• D: OSA patients with PAP use ≥4 h/day.

The mean age of the cohort was 54 and 60.2% were men. “As expected, the OSA cohort was older, more likely to be male, more obese, and had a greater degree of baseline comorbidities,“ Dr Hwang described the patient characteristics. In numbers, this equalled a mean BMI of 30.4 in the no-OSA group (group A) and 34.3 in group B, a Charlson Comorbidity Index of 1.3 (group A) versus 2.0 (group B), and a percentage of men of 44% versus 60.3%, respectively.

The results showed the highest COVID-19 infection rate of 2.1% in those with OSA, but poor use of PAP (group B). In comparison, 1.7% in group A and group C contracted COVID-19, and OSA patients with the best adherence to their PAP treatment (group D) had the lowest incidence of COVID-19: 1.3%. These findings were corroborated by the results of an adjusted model that calculated the odds ratio (OR) of infection for group A versus group B equalling 0.82. In a comparison of well-treated (≥4 h/day, group D) versus not adequately treated (≤2 h/day, group B) OSA the OR was 0.68. “Clinical factors such as obesity and more comorbidities at baseline were also associated with a higher rate of becoming infected,” Dr Hwang said. Unexpectedly, a lower infection likelihood was found for older patients with an OR of 0.88 for every increase of 5 years. “The association of demographic factors with risk suggests social-behavioural influences, while the association of clinical factors could suggest biologic mechanisms. Neither OSA nor PAP was associated with COVID-19 severity outcomes, but the overall incidence rates were small,“ Dr Hwang concluded.

1. Hwang D. Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes. Session B014: Pathophysiology, cardiovascular disease, and COVID-what’s happening in sleep research right now. ATS 2021 International Conference, 14-19 May.

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Posted on 5 July 202117 May 2024