Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study.

J P T F Ho,N Su,J De Lange,N Zhou,K Schipper,H C M Donders,Claudio Andaloro

doi:10.1371/journal.pone.0257483

Abstract

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity–based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days–were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA–based on AHI, ODI, and RDI–and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

Highlights

Coronavirus disease 2019 (COVID-19) is an infectious disease, caused by the betacoronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]
Electronic medical records from COVID-19 patients–from outpatients from the Isala Hospital and patients admitted to the Isala Hospital (Zwolle, the Netherlands)–starting from March 1 until December 31, 2020 were accessed
From March 1 until December 31, 2020, 1730 patients were identified in the Isala Hospital with COVID-19

Summary

Introduction

Coronavirus disease 2019 (COVID-19) is an infectious disease, caused by the betacoronavirus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. Due to the high transmission rate of this disease, it rapidly developed into a global pandemic with millions of confirmed deaths reported to the World Health Organization (WHO) [3, 4]. As vaccinations for SARS-CoV-2 successfully passed the trial phase and have been approved, they are being administered globally. The strategy to apply social distancing and to use face masks still applies [5]. Another strategy that is gaining more interest, is to try to eliminate or optimize the control of risk factors for patients infected by COVID-19. More and more detailed evidence on the risk factors associated with COVID-19 is becoming available, such as hypertension, cardiovascular disease (CVD), diabetes, and respiratory disease [6, 9,10,11]

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