Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What is OSA? | OSA & COVID | OSA Worsen COVID? | Risk of COVID Infection | Treatment | Diagnosis
Introduction
Obstructive sleep apnea (OSA) is the most common breathing-related sleep disorder. Studies show that it affects a mean of 22 percent of men and 17 percent of women.[1]
Since the early pandemic days, doctors have noticed that patients with OSA have worse coronavirus infection outcomes, including being more likely to be hospitalized, developing severe complications, requiring ICU care, and even dying from COVID infection.[2]
Some researchers suggest that OSA increases the risk of infection with COVID; however, this remains a topic of debate.[2]
If you suspect that you might have OSA, you should seek evaluation by a sleep specialist. Getting OSA under control might help improve the outcomes of COVID infection. It’s also essential to prevent heart disease, hypertension, and metabolic diseases – other complications of OSA.
What is OSA?
OSA is the most common sleep-related breathing disorder. People with OSA have recurrent pauses in their breathing due to temporary airway collapse, leading to poor sleep quality and symptoms like:
- Snoring
- Waking up repetitively from sleep, usually gasping for air
- Excessive daytime sleepiness
- Tiredness and irritability
The recurrent breathing pauses during sleep lead to low oxygen levels, known as hypoxia. This physiological response is how obstructive sleep apnea affects other vital organs, like the heart and brain.
OSA is common, affecting more than 20 percent of the elderly population.[5] Prevalence is as high as 50 percent in some countries.[2] Unless properly treated, it’s a risk factor for heart, lung, and metabolic diseases.
OSA & COVID
Does OSA intensify COVID symptoms? The answer to this question is quite simple: yes. Since the early days of the coronavirus pandemic, sleep and lung specialists knew that OSA patients were more vulnerable than others.
Since then, several studies have shown that OSA can increase the risk of complications, severe disease, hospitalization, and death in COVID patients.
One study done in 2021 included 445 COVID patients, 8.5 percent of whom had already been diagnosed with OSA (almost the same rate as the general population).[5]
Interestingly, when the researchers looked at those with severe COVID, they noticed more patients with OSA – almost 36 percent. This finding led researchers to postulate that OSA is associated with more severe diseases.
Further analysis found that patients with OSA and severe COVID were two times more likely to need hospitalization than those without sleep apnea.[5]
Another study that included almost 10,000 patients found that patients with OSA were more likely to need hospitalization and progress to respiratory failure than non-OSA patients.[2]
Now, researchers are trying to find a more specific connection between OSA and coronavirus infection.
One study recently published in JAMA has concluded low average nighttime oxygen (less than 90 percent) was a specific risk factor for worse COVID outcomes.[3]
To summarize, most studies show that obstructive sleep apnea leads to worse COVID outcomes.
How Does OSA Worsen COVID?
Sleep and pulmonary specialists have been studying the relationship between coronavirus infection and OSA ever since the pandemic started.
We’re trying to determine how COVID and OSA are related and how OSA worsens the disease course.
OSA is a multisystem illness. Chronic nighttime hypoxia (blood oxygen shortage) is a risk factor for other dangerous disorders, including:
- Diabetes
- Hypertension
- Heart disease
- Stroke
- Lung disease
In other words, patients with OSA and infected with the coronavirus are more vulnerable to other diseases. Nevertheless, studies also show that having OSA is a risk factor for severe COVID regardless of all other factors like age, sex, and comorbidities.[5]
The exact mechanism of how chronic hypoxia worsens the outcomes of COVID and leads to more mortality remains to be explored by future research.
OSA & the Risk of COVID Infection
The data is conflicting when it comes to OSA and the risk of contracting COVID.
One study published in 2020 showed that patients with OSA are eight times more at risk of catching COVID.[2]
Newer studies that include more variables have found that OSA increases the risk of severe disease but not catching COVID. However, several other studies have contradicted this finding.
The study in The Journal of the American Medical Association (JAMA) cited above, for example, found no relationship between having OSA and testing positive for the coronavirus.[3]
Future studies are expected to shed more light on whether or not having OSA puts you at a higher risk of corona infection.
Treatment of OSA and Risks of COVID
Data is still inconclusive regarding whether treating obstructive sleep apnea reduces the risk of severe COVID.
Nevertheless, sleep doctors believe treating OSA reduces the risk of serious illnesses, such as diabetes, hypertension, heart disease, and stroke.
These conditions are already known to be risk factors for poorer COVID outcomes. Preventing those comorbidities or getting them under control should reduce vulnerability for severe corona outcomes.[4]
So, whether or not COVID risk is directly reduced, getting help is still worth it.
OSA Diagnosis and Treatment
Diagnosing and properly treating obstructive sleep apnea might decrease the risk of severe illness due to COVID. If your sleep specialist suspects you might have OSA, they will recommend a sleep study, also called polysomnography.
Once a diagnosis of OSA is established, a treatment plan will be designed to treat your specific case and may include lifestyle changes, oral devices, a ventilator (CPAP), or even surgery.
References:
- Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population-a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-1322. doi:10.3978/j.issn.2072-1439.2015.06.11
- Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure. Sleep Breath Schlaf Atm. Published online September 29, 2020:1-3. doi:10.1007/s11325-020-02203-0
- Pena Orbea C, Wang L, Shah V, et al. Association of Sleep-Related Hypoxia With Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System. JAMA Netw Open. 2021;4(11):e2134241. doi:10.1001/jamanetworkopen.2021.34241
- Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Med Rev. 2021;55:101382. doi:10.1016/j.smrv.2020.101382
- Strausz S, Kiiskinen T, Broberg M, et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res. 2021;8(1):e000845. doi:10.1136/bmjresp-2020-000845
