COVID-19 Clinical Outcomes in Hospitalized Patients with Obstructive Sleep Apnea

Introduction: COVID-19 is caused by the novel coronavirus SARS-CoV-2. Existing literature indicates that obstructive sleep apnea (OSA) is an independent risk factor for poor COVID-19 outcomes, and a pro-inflammatory state and immune dysregulation have been suggested as mechanisms underlying both conditions. Objective: The aim of this retrospective matched case-control study is to evaluate clinical factors associated with COVID-19 severity in hospitalized patients with a clinically documented history of OSA compared to a control group of hospitalized COVID-19 patients with no documented history of OSA. Materials and Methods: The UIC COVID-19 Registry for Research (Registry), a database containing demographic and a breadth of longitudinal clinical information of the first case series of patients who were hospitalized at UI Health between January 1 and May 6, 2020 and tested positive for COVID-19 between March 20 and April 30, 2020, was examined to identify patients with a documented history of OSA. Patients with OSA were matched 1:1 to control patients from the same Registry with no documented history of OSA. Cases and controls were matched based on: sex, age ± 3 years, race, ethnicity, and BMI category. Outcomes included symptoms at diagnosis, oxygen support, ICU admission, vitals, blood oxygen saturation, inflammatory biomarkers, inpatient length of stay, readmission beyond 20 days after testing positive until August 30, 2020, mortality, and CPAP use and adherence were selected to represent COVID-19 severity and were collected from the Registry and from electronic medical records. Results: Of the 251 patients in the Registry who were hospitalized at UI Health, 41 cases with a documented history of OSA and 41 matched controls with no documented history of OSA were identified. Based upon matching, there were no statistically significant differences in demographic variables between cases and controls; overall, mean age was 57.5 ± 12.0 years, 48% were male, 63.4% were Black, 69.5% were non-Hispanic/Latino, and 75.6% had a BMI category of obese. Patients without OSA versus with OSA, respectively, were more likely to present at baseline with respiratory distress (41.5% vs. 19.5%; p=0.03) and chills (43.9% vs. 22.0%; p=0.03). Patients with OSA versus without OSA, respectively, were more likely to require oxygen support via nasal cannula (65.9% vs. 43.9%; p=0.046) and non-invasive ventilation (9.8% vs. 0%; p=0.04) as the maximum O2 support needed during admission. No statistically significant differences were found between inpatient length of stay, ICU admission, baseline levels of inflammatory markers, number of readmissions, and mortality. Conclusion: Despite being less likely to present with respiratory distress, patients with OSA were more likely to require advanced levels of oxygen support during admission. Future research will be required to evaluate the role of potential respiratory compensations in patients with OSA, particularly in regard to respiratory challenges such as COVID-19.