Adults with obstructive sleep apnea (OSA) are more likely to experience postacute sequalae of SARS-CoV-2 (PASC), or long COVID, according to study findings published in the journal Sleep.
Previous research has found that having preexisting OSA affects the outcomes of an episode of acute coronavirus disease-2019 (COVID-19), but few have examined the outcomes beyond acute illness. This study is the first large-scale, multi‑cohort study to assess whether having OSA poses a risk for long COVID in those who contract the disease, according to researchers.
The researchers obtained data from electronic health records (EHRs) from 3 research networks in the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER) initiative, including the National COVID Cohort Collaborative (NC3; 1,783,940 million adults); the National Patient-Centered Clinical Research Network (PCORnet; 333,642 adults); and PEDSnet (106,262 children), a pediatric learning health system within PCORnet. Participants included in the analysis tested positive for COVID-19 between March 2020 and February 2022.
The majority of patients in the N3C and PCORnet cohorts were non-Hispanic White (50-68%) and more than half the patients were female (32% and 60%); 43% of children in the pediatric cohort were non-Hispanic White with the majority being male (51%).
Using this data, the researchers calculated the unadjusted odds ratios (ORs) of having long COVID in patients with COVID-19 vs those without an OSA diagnosis before the onset of the pandemic. They also calculated these ORs by adjusting for age bracket, sex, race or ethnicity, hospitalization status, obesity, and preexisting comorbidities such as asthma, diabetes, obesity, and hypertension.
The calculated unadjusted ORs for probable long COVID were higher in adults with a preexisting OSA diagnosis, compared with those without an OSA diagnosis (N3C: OR, 3.93 [95% CI, 3.84-4.02]; PCORnet: OR, 1.41; 95% CI, 1.36-1.46). After adjusting for demographic factors, hospitalization, obesity, and comorbidities, the correlation was still significant among adults.
In the PEDSnet cohort, unadjusted ORs (3.28; 95%, 2.85-3.76) suggested a significant risk for long COVID among children with OSA vs children without OSA. However, after adjusting for demographic factors, obesity, comorbidities, and hospitalization, there were no significant differences in odds of long COVID in this cohort among children with and without OSA (OR, 1.05; 95% CI, 0.86-1.24.
The researchers proceeded to conduct a sensitivity analysis in a subset of patients with a positive lab test or diagnosis for COVID-19 to reexamine the association between preexisting OSA and probable development of long COVID. In this expanded inclusion criteria, there were an additional 2,999 patients in PEDSnet, 78,103 patients in PCORnet, and 185,928 patients in N3C included in the analysis.
Similar to the primary analysis, after adjusting for sex, race/ethnicity, age group, and hospitalization at the time of index, the odds of developing long COVID were higher among patients with preexisting OSA, compared with those without preexisting OSA. The results of an interaction analysis were not significant in PEDSnet or PCORnet. In NC3, the results suggested OSA in men increased the odds for long COVID by 59% compared with an 89% increase in women (P <.001). However, these associations were not clear.
Study limitations included possibly spotty documentation of COVID diagnoses, race, and ethnicity in the EHR, lack of adjustment for COVID vaccination status or active treatment of OSA, and an inability to include data on OSA severity in the analysis. The latter limitation indicates that the analysis findings may not apply to all levels of severity of OSA.
“Adults with preexisting OSA had increased odds of developing PASC and may benefit from increased monitoring after SARS-CoV-2 infection,” the researchers concluded. However, they added that “additional research is needed to elucidate the role of severity and treatment.”
Mandel HL, Colleen G, Abedian S, et al. Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative. Sleep. Published online May 11, 2023. doi:10.1093/sleep/zsad126