Preexisting obstructive sleep apnea (OSA) is associated with up to a 75% increased risk of long COVID in adults, according to a recent analysis from the National Institutes of Health (NIH) RECOVER collaboration. The investigators found that unadjusted odds of post-acute sequelae of SARS-CoV-2 (PASC) were significantly higher for adult and pediatric patients with a pre-pandemic OSA diagnosis, according to electronic health record (EHR) data from three research networks. However, following adjustment for factors including hospitalization, obesity, and comorbidities such as diabetes and hypertension, the association between previous OSA and PASC was reduced by various degrees and only remained significant in adults. Women with OSA in the N3C study had an 89% increased odds of long COVID as compared with a 59% increased odds for men with OSA. Long COVID comprises neurological, respiratory, and other symptoms that people experienced weeks, months, or even years after they contracted the virus. In a conservative estimate, long COVID is said to impact approximately 10% of the population that had or will develop a COVID-19 infection.
The nationwide, real-world data utilized EHRs to detect incident PASC. Participants were pooled from one of three cohorts: National COVID Cohort Collaborative (N3C), National Patient-Centered Research Network (PCORnet), and PEDSnet. The N3C and PCORnet networks included the majority of patients, while in the PEDSnet cohort, there were far fewer patients with previous OSA or PASC. The majority of patients in the NC3 and PCORnet adult networks were non-Hispanic white, while 43% were non-Hispanic white in the pediatric cohort. Additionally, the investigators found that over half of patients in the NC3 and PCORnet adult networks were female, whereas the majority were male in the PEDSnet cohort.
“In this harmonized analysis, we found that preexisting OSA was associated with an increased risk of PASC-like conditions among adult patients in the RECOVER EHR research networks, despite different approaches for identification of probable PASC patients,” the group wrote in Sleep. The investigators recommended that monitoring of adult patients with OSA, as well as active steps toward preventing and managing COVID-19, are essential steps for clinicians. Further, study authors acknowledged that limitations of their analysis include potential inconsistencies in the documentation of COVID-19 cases in their EHR data and lack of adjustment for patient vaccination status.
The NIH-funded study could potentially help inform clinical care by identifying patients who may benefit from closer monitoring. Hannah Mandel, MS, a senior data scientist at the New York University Grossman School of Medicine in New York City, stated that “People with sleep apnea who get infected with COVID should seek early treatment, pay attention to their symptoms, and keep up with their vaccines to lower the risk of infection in the first place.” However, more research on long COVID is still necessary. While the study showed a significant association between OSA and long COVID, more data needs to be collected to establish a causal relationship. Nevertheless, clinicians can now keep watchful monitoring on patients with pre-existing OSA and ensure they take proactive measures to safeguard against COVID-19.
