Association of Diagnosed Obstructive Sleep Apnea with Hospitalization and Mortality in a Retrospective New York City COVID-19 Surge Cohort with a Risk Prediction Model

Abstract

Background: COVID-19 infection is more severe in patients with obstructive sleep apnea (OSA) with unclear modification by risk factors. Additionally, there is no scoring algorithm for probability of admission. Methods: On 8/4/2020 we queried New York City Health and Hospitals system database for patients above 15 years old who tested positive for COVID-19 during the surge. The target was diagnosed OSA. The timeframe was between 3/24/2020 and 6/7/2020 with limited elective hospital admissions. We calculated case-control-matched odds ratios for admission, intubation, and death. Additionally, we introduced a scoring system to predict the probability of admission due to COVID19 infection in the presence of OSA and other comorbidities. Results: Out of 19,593 COVID positive patients 306 (1.6%) had documented OSA. On multivariate analysis, the adjusted odds ratios for patients with OSA were 2.04 (CI 1.32-3.16, p 0.001) for admission, 1.05 (0.73-1.52, p 0.784) for intubation and 1.23 (CI 0.95-1.61, p 0.122) for mortality. After matching and comparing to a randomly selected non-OSA patients, the adjusted odds ratio for the same outcomes were 2.21 (1.41-3.46, p <0.001)-admission, 1.28 (0.83-1.98, p 0.256)-intubation and 1.69 (1.24-2.28, p<0.001)-mortality. Per our developed 11-point scoring algorithm, the risk of admission for these patients is almost 90% when the summation of points is as a low as 4 out of 11. Conclusion: Diagnosis of OSA is associated with hospital admission and mortality in COVID patients. This should be considered during triage and therapy decisions. Presented scoring model for estimated risk of admission could serve as a quantitative tool to estimate risk of admission.