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

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.

Obstructive Sleep Apnea (OSA) and COVID-19: Mortality Prediction of COVID-19-Infected Patients with OSA Using Machine Learning Approaches

“…According to Ref. [19], there are 24 columns in the dataset, among which the mortality of the patients is tested as the target variable while the rest of the columns are trained and tested as training variable. The columns are as follows: mortality of patients, WHO categories, hospital admission, gender, treatment for obstructive sleep apnea, smoking, diabetes mellitus (DM), cardiovascular disease (CVD), asthma, chronic kidney disease, active malignancy, and immune suppression, which are all categorical variables.…”

“…The dataset was collected from the paper "Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective crosssectional study" [19]. The paper studied the relation between obstructive sleep apnea and the degrees of risk associated with it on COVID-19-infected patients.…”

“…According to Ref. [19], the dataset was constructed from patients from Isala Hospital (Zwolle, the Netherlands) from March to December 2020. Adults above the age of 18, patients with polysomnography (PSG) or home sleep apnea testing (HSAT), positive for COVID-19 disease, and containing mild to severe obstructive sleep apnea (OSA) were included for the study.…”

“…The gender attribute for the sample was encoded as Male: 0, Female: 1. The rest of the attributes of the samples were already encoded into the uploaded dataset by [19] with 1 as positive and 0 as not positive in answer to the attribute. For the column "smoking entire life", 0 represents that the person has never smoked, 1 represents that the person has smoked in his life, and 2 represents that the smoking habit is still present in the person.…”

Impact of Obstructive Sleep Apnea (OSA) in COVID-19 Survivors, Symptoms Changes Between 4-Months and 1 Year After the COVID-19 Infection

“…To date, most of the data published on the risk factors for the pneumonia in COVID-19 and long-term sequelae (as example: male gender, age, obesity, hypertension, diabetes) are also recognized as clinical risk factor for increased risk of obstructive sleep apnea (OSA) ( 8 – 11 ). However, data about the association between OSA and COVID-19 is limited to few studies, including indirect measures such as questionnaires, or secondary analysis of databases ( 1 , 8 , 12 , 13 ).…”