Sleep Apnea Patients Prone to Higher Long COVID Risk

Preexisting obstructive sleep apnea (OSA) was associated with up to a 75% increased risk of long COVID in adults, an analysis from the NIH RECOVER collaboration found.

Unadjusted odds of post-acute sequelae of SARS-CoV-2 (PASC) were significantly higher for adult and pediatric patients with a prepandemic OSA diagnosis, according to electronic health record (EHR) data from three research networks.

But following adjustments 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:

• Adults in the National COVID Cohort Collaborative (N3C) cohort (OR 1.75, 95% CI 1.71-1.80)
• Adults in the National Patient-Centered Clinical Research Network (PCORnet; OR 1.12, 95% CI 1.08-1.16)
• Children in the PEDSnet cohort (OR 1.05, 95% CI 0.89-1.24)

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 (P<0.001), according to the researchers led by Hannah Mandel, MS, a senior data scientist of the New York University Grossman School of Medicine in New York City.

"In this harmonized analysis, we found that preexisting OSA was associated with 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 said that monitoring of adult patients with OSA, as well as active steps toward preventing and managing COVID-19, are important steps for clinicians.

"There's still so much to uncover about long COVID, but this study will inform clinical care by identifying patients that should be watched more closely," said Mandel in a news release. "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."

Long COVID comprises the various neurological, respiratory, and other symptoms that people have experienced weeks, months, or even years after SARS-CoV-2 infection. The CDC defines long COVID as symptoms that start at least 4 weeks after infection, while the World Health Organization defines it by symptoms that persist for at least 3 months.

In a conservative estimate, long COVID is said to impact approximately 10% of the population that had or will develop a COVID-19 infection.

"We still have a lot to learn about the long-term effects of this virus, but this study could inform clinical care by identifying patients who may benefit from closer monitoring," said Marishka Brown, PhD, director of the National Center on Sleep Disorders Research at the National Heart, Lung, and Blood Institute, in an NIH statement.

The present study relied on nationwide real-world data from EHRs to detect incident PASC. Participants were pooled from one of three cohorts:

• N3C: 1,783,940 adult COVID-19 patients included, 3.9% of whom had OSA prior to COVID-19 diagnosis and 4.9% of whom developed probable PASC
• PCORnet: 333,642 adult COVID-19 patients, 5.1% of whom already had OSA and 16.6% of whom developed probable PASC
• PEDSnet: 106,262 pediatric COVID patients, 1.8% of whom had previous OSA and 4.6% of whom developed probable PASC

Of the N3C and PCORnet adult networks, the majority of patients were non-Hispanic white (50-68%), while 43% were non-Hispanic white in the pediatric cohort. More than half of patients in the NC3 and PCORnet adult networks were female (62% and 60%), while the majority were male in the PEDSnet cohort (51%).

Study authors acknowledged that limitations of their analysis include potential inconsistencies in the documentation of COVID-19 cases in their EHR data, as well as the lack of adjustment for patient vaccination status.

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