COVID-19 infection risk in sleep apnoea linked to adequate apnoea treatment

A retrospective study identified a reduced risk of contracting COVID-19 when patients with obstructive sleep apnoea were treated with positive airway pressure therapy for at least 4 hours a day.

The study included 81,932 patients, all of which had enrolled in a Kaiser Permanente health plan before February 2020, with no priors of COVID-19 [1]. “We specifically looked at adults and patients with daily positive airway pressure (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 SARS-CoV-2 infection rates and measurements of COVID-19 severity,” explained Dr Dennis Hwang (Kaiser Permanente, California, USA). The study population was sorted into 4 groups:

• A: patients without obstructive sleep apnoea (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 male. “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 and 34.3 in group B, a Charlson Comorbidity Index of 1.3 (group A) versus 2.0 (group B), and a percentage of male participants of 44% versus 60.3%, respectively.

The highest SARS-CoV-2 infection rate of 2.1% was observed 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 those 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, and in a comparison of well treated (≥4 h/day) versus not adequately treated (<2 h/day) OSA the OR was 0.68. “Clinical factors such as obesity and a greater degree of 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. “We did not find a relationship between OSA nor PAP therapy with the rate of hospitalisation nor the need for ICU care or death,” Dr Hwang further elaborated.

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.

Posted on 18 May, 20214 August, 2021