Nov. 15, 2021 -- People with sleep disorders are no more likely than other adults to get infected with coronavirus and develop COVID-19. However, if infected, they are at a 31% higher risk of being hospitalized or dying from the illness, new research reveals.

Investigators looked at almost 360,000 patients tested for COVID-19 at the Cleveland Clinic system. This group included 5400 people who also completed a sleep study.

They also accounted for other factors that could alter COVID-19 risk, including obesity, heart and lung disease, cancer, and smoking.

The study was published November 10 in JAMA Network Open.

Asked if she was surprised by the 31% increased risk,

Cinthya Pena Orbea, MD,

says, "While this was consistent with our a (existing) hypotheses and we were careful to take in to account pulmonary disease and smoking history, we still identified a statistically significant association."

Pena Orbea is on staff at the Sleep Disorder Center and is assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine.

The study is important because it helps identify another group at potential risk for worse outcomes from COVID-19 and may help put assets and resources where needed, senior study author Reena Mehra, MD, director of sleep disorder research at the Cleveland Clinic, said in a news release.

“As the COVID-19 pandemic continues and the disease remains highly variable from patient to patient, it is critical to improve our ability to predict who will have more severe illness,” she said.

The study may help doctors adjust. “Should a patient with sleep apnea develop COVID19 infection, then perhaps they should be prioritized or triaged to receive anti-COVID therapies that have been in short supply at times," Indira Gurubhagavatula, MD, MPH, chair of the American Academy of Sleep Medicine's COVID-19 Task Force, says.

Exact Mechanism a Mystery

Why people with sleep disorders may develop more severe COVID-19 remains unknown, but inflammation may play a role, Mehra noted.

Gurubhagavatula says that makes sense.

"We know that people who develop severe COVID-19 infection seem to do so because of a 'cytokine storm,' which is an overwhelming inflammatory load that leads to injury to organs, including lung tissue,” she says"

"We also know that sleep apnea itself causes increased inflammation," says Gurubhagavatula.

Previous studies do, however, seem to agree that inflammation could be key. Other researchers, for example, have linked low blood oxygen levels to signs of inflammation, including higher white blood cell counts, in people with COVID-19.

It could also have direct effects on the lungs.

Next Steps

The research also offers important clues as to how to move forward in managing the large population of patients who have sleep apnea and develop COVID-19 infection, Gurubhagavatula says.

Unanswered questions, for example, include: Should we encourage patients who are on CPAP to use their machines fully to limit their risk of developing worse outcomes from COVID-19? Should we prioritize patients with obstructive sleep apnea who develop COVID-19 to receiving therapies against the infection?

Pena Orbea and colleagues plan to continue this research.

Medscape Medical News

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