Sleep apnea and a chronic condition increase the risk of Covid in the long run

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Adults who have obstructive sleep apnea have up to a 75% increased risk, on average, of developing prolonged Covid after a SARS-CoV-2 infection compared to people without sleep apnea, a new study has found.

Women with obstructive sleep apnea had up to an 89% increased risk, while men had a 59% increased risk, based on analysis of electronic health data from nearly 1.8 million people.

Obstructive sleep apnea is a potentially dangerous disorder in which breathing stops for about 10 seconds multiple times throughout the night due to airway obstruction by heavy or relaxed soft tissue in the mouth and throat.

A second analysis of medical records from a smaller group of 330,000 adults found the risk to be just 12%, according to the study, which is part of RECOVER, or Researching Covid to Enhance Recovery. RECOVER is an initiative of the National Institutes of Health dedicated to understanding why some people develop Covid for a long time and how best to detect, treat and prevent the condition.

Why the big difference in numbers? People in the largest study had additional health problems or comorbidities, such as obesity, diabetes, high blood pressure and heart disease, said study lead author Lorna Thorpe, Co-Director of the RECOVER Clinical Science Core at NYU Langone Health.

“The range of 12% to 75% is likely due to a mix of different study populations and different levels of comorbidities, but also different definitions of long covid,” he said. “We didn’t even have a diagnosis code for long Covid until October 2021.

“I think the risk is probably somewhere in the middle, but we’ll need additional studies to find out,” added Thorpe, a professor and director of the division of epidemiology at NYU Grossman School of Medicine.

A third analysis of the medical records of 102,000 children with sleep apnea found no correlation between sleep apnea and prolonged covid after several confounding factors. Health conditions were ruled out, “which of course is great news,” Thorpe said.

“By using three very large networks of electronic health records, we were able to do this study three times, which is one of the strengths of the research,” he added. “This study is the first collaboration of this approach and scale to find that adults with sleep apnea are at increased risk of prolonged covid.”

This is an “important study” on prolonged Covid, said Dr. Sairam Parthasarathy, Principal Investigator, Arizona Health Sciences University RECOVER Adult Study and professor of medicine.

“Investigation in a prospective study should be done to verify this association, and if these findings are found to be true, they have implications for the treatment of long-term covid,” said Parthasarathy, who was not involved in the study.

“It is important to note that some of the symptoms of long-term covid, such as fatigue, may be related to obstructive sleep apnea, and that obstructive sleep apnea treatment may improve long-term covid-related symptoms. ”, he added.

The study, published Thursday in the journal Sleep, is one of several studies published since Congress appropriated $1.15 billion to the NIH in January 2021, to study the long-term effects of Covid over a four-year period. To date, the agency says it has used about $811 million to fund research.

The researchers wanted to investigate the role of sleep apnea in prolonged covid because of the known association between the condition and worse outcomes after a covid infection.

“People with sleep apnea are at increased risk of a more severe case of COVID-19, admission to hospital intensive care, and mortality,” Thorpe said.

“Obstructive sleep apnea can cause increased inflammation, which could disrupt sleep, leading to an increased propensity to develop infections and reduced immunity,” said Dr. Bhanu Prakash Kolla, a medical specialist. of sleep at the Mayo Clinic Sleep Medicine Center in Rochester. Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea leads to an increased risk of having covid and also … (long covid),” said Kolla, who was not involved in the study.

Sleep apnea is an underdiagnosed condition regardless of gender, said Parthasarathy of the University of Arizona.

“It is conservatively estimated that 80% of patients with obstructive sleep apnea (OSA) are not diagnosed,” he said. Furthermore, “one assumption with these analyzes is that patients with OSA are likely to be treated. However, almost half of them they are not using the treatment.”

Why would women have up to 89% higher risk compared to 59% in men? The study did not address that issue.

However, “one can postulate that this difference may be based on what we know about sex differences in sleep and immune responses,” said Dr. Phyllis Zee, director of the Center for Sleep and Circadian Medicine at the College of Feinberg Medicine from Northwestern University in Chicago.

Zee, who was not involved in the new research, co-authored one of the first published studies on the link between sleep apnea and severe covid infection.

“Women typically have stronger immune responses to viral infections and are therefore also vulnerable to post-infection inflammation,” Zee said. “Women in general have more insomnia and with long Covid they tend to have symptoms of fatigue and insomnia, which are also common symptoms of long Covid.”

Another reason could be that sleep apnea has historically been considered a male disease, Thorpe said, which could mean that by the time a woman is diagnosed, her apnea is more advanced.

“It could be that women who are documented in electronic health records have more severe sleep apnea because doctors are looking more often for sleep apnea among men,” she said.

As scientists continue to learn more about long covid, more information will become available, Thorpe said. Meanwhile, people who have sleep apnea, or who snore, wheeze and stop breathing at night, which are all signs of the condition, need to be very careful when they come in contact with Covid.

“People with sleep apnea who become infected with Covid should seek treatment early and consider getting paxlovid, the oral medication prescribed to reduce the risk of serious outcomes,” Thorpe said. “They should also keep up with their vaccinations to reduce the risk of infection in the first place.”