Study finds that sleep apnea increases likelihood of severe coronavirus outcomes

[colomom]

“Adults with sleep apnea — a disorder in which breathing repeatedly stops and starts during sleep — are at higher risk for the most severe outcomes of covid-19, according to a new study.
The study, published Wednesday on JAMA Network Open, shows a team of researchers found that those with the sleep disorder are 31 percent more likely to be hospitalized and 31 percent more likely to die after contracting the coronavirus, the virus that causes covid-19.”
https://www.washingtonpost.com/nation/2 ... e-updates/

https://jamanetwork.com/journals/jamane ... erm=111021

[ChicagoGranny]

“Adults with sleep apnea — a disorder in which breathing repeatedly stops and starts during sleep — are at higher risk for the most severe outcomes of covid-19, according to a new study.

That is poor reporting by the Washington Post writers. Look at the actual study --->

Our current results, however, suggest that chronic exposure to sleep-related hypoxia may serve as a priming mechanism to the untoward consequences of COVID-19 illness.

Going back to the WAPO quote, it is not "adults with sleep apnea". It is adults with sleep apnea who fail to treat it effectively.

If you use CPAP and have your therapy optimized, you shouldn't be regularly exposed to hypoxia. I hope all the members who have been here any length of time are no longer having significant hypoxia while sleeping.

A thing that concerns me is reports of coughing with COVID-19. I know a lady who coughed for three months after infection. That could be tough on someone (like me) using CPAP.

[MMcG]

More than likely it's a classic example of inferring causation from association. I'll accept the association at face value. But then when you see that sleep apnea is also associated with increased obesity and age, and that those two are also associated with severe COVID illness, a more complex picture emerges. Causation is very difficult to prove without double blind studies - hard to know how one would set that up with COVID/apnea without deliberately exposing vulnerable people!

[ChicagoGranny]

Some of your concerns are addressed in this article which replies to the subject study --->

... further research is warranted to understand whether sleep apnea–related hypoxemia, endothelial dysfunction, coagulopathy, inflammation, cardiac dysfunction, and other related pathologies contribute to the excessive COVID-19 morbidity and mortality.

https://www.atsjournals.org/doi/full/10 ... 101-0210LE

[colomom]

Going back to the WAPO quote, it is not "adults with sleep apnea". It is adults with sleep apnea who fail to treat it effectively.

If you use CPAP and have your therapy optimized, you shouldn't be regularly exposed to hypoxia. I hope all the members who have been here any length of time are no longer having significant hypoxia while sleeping.

A thing that concerns me is reports of coughing with COVID-19. I know a lady who coughed for three months after infection. That could be tough on someone (like me) using CPAP.

I use my CPAP religiously and my OSA would nearly always be considered well treated, but sometimes when I’m sick I can’t tolerate CPAP. If I’m severely congested, my nasal mask makes me feel completely air starved and I can’t use it. I also struggle with using my cpap when I have a bad cough.

I find the findings quite significant, primarily because I don’t understand why OSA wasn’t included in the list of medical conditions that qualify you for a COVID booster. Here in Colorado we’re having a huge COVID surge that is overwhelming our hospitals, yet I wasn’t able to get a booster shot until a couple of days ago when Colorado’s Governor issued an executive order that opened boosts up to everyone over 18. Today 6 people I know including my husband’s coworker found out they had COVID (one of the six was a breakthru case).

The broader point I was trying to make with my post is that I think this shows OSA puts us all into a higher risk category. For anyone who is eligible for a booster and haven’t gotten it yet, get that boost!

[colomom]

More than likely it's a classic example of inferring causation from association. I'll accept the association at face value. But then when you see that sleep apnea is also associated with increased obesity and age, and that those two are also associated with severe COVID illness, a more complex picture emerges. Causation is very difficult to prove without double blind studies - hard to know how one would set that up with COVID/apnea without deliberately exposing vulnerable people!

The study accounted for underlying conditions commonly found in sleep apnea patients:

“Objective To investigate the association of SDB (identified via polysomnogram) and sleep-related hypoxia with (1) SARS-CoV-2 positivity and (2) World Health Organization (WHO)-designated COVID-19 clinical outcomes while accounting for confounding including obesity, underlying cardiopulmonary disease, cancer, and smoking history.”

[MMcG]

More than likely it's a classic example of inferring causation from association. I'll accept the association at face value. But then when you see that sleep apnea is also associated with increased obesity and age, and that those two are also associated with severe COVID illness, a more complex picture emerges. Causation is very difficult to prove without double blind studies - hard to know how one would set that up with COVID/apnea without deliberately exposing vulnerable people!

The study accounted for underlying conditions commonly found in sleep apnea patients:

“Objective To investigate the association of SDB (identified via polysomnogram) and sleep-related hypoxia with (1) SARS-CoV-2 positivity and (2) World Health Organization (WHO)-designated COVID-19 clinical outcomes while accounting for confounding including obesity, underlying cardiopulmonary disease, cancer, and smoking history.”

I just read the study fully. It's published in a fairly reputable open online site, but probably not peer reviewed. The latter is important because of the complex statistical analysis used to allow for co-morbidities. I have some grounding in mathematics but am not a statistical expert. But taking it at face value, the study finds that there is an "association" between people who've been diagnosed with sleep apnea and people having relatively severe COVID disease. As far as I can make out, the study didn't establish whether those people were on CPAP treatment prior or subsequent to the sleep study. But regardless, it's still just an association. It doesn't prove causation, even it it's intuitively plausible. It's well known that prolonged untreated sleep apnea can cause heart disease and it's very likely that many with sleep apnea have undiagnosed heart issues. The study adjusts for known (presumably diagnosed) co-morbidities including heart disease, but could not, of course, account for undiagnosed conditions. But it seems plausible to me that there would be a greater propensity to undiagnosed heart disease among the apnea cohort as opposed to the "control" group. So one has to be careful about statistical association in the absence of other evidence.

[colomom]

I just read the study fully. It's published in a fairly reputable open online site, but probably not peer reviewed.

The study was on the JAMA open website. JAMA is an acronym for The Journal of the American Medical Association. Every article posted on the site including this study is peer reviewed.

“Building on the editorial excellence of JAMA®, the Journal of the American Medical Association, JAMA Network Open™ and the 10 JAMA Network™ specialty journals offer enhanced access to the research, reviews and perspectives shaping medicine today and into the future…A network of 12 peer-reviewed journals”
https://www.ama-assn.org/about/publicat ... ma-network

[chunkyfrog]

" . . . the study didn't establish whether those people were on CPAP treatment prior or subsequent to the sleep study. . . . "
This happens all the time.
I guess the extra work involved with confirming actual cpap use (and efficacy)
made them think, " Eff it; Let's just ASSume treatment is not important."
Everybody is in a hurry to publish, and enough "peers" are guilty of the same
generalities--they agree to ignore that.--CYAs all around.

[ChicagoGranny]

Every article posted on the site including this study is peer reviewed.

+1

[ChicagoGranny]

As far as I can make out, the study didn't establish whether those people were on CPAP treatment prior or subsequent to the sleep study.

Actually, it did, and there is a discussion.

... however, we believe this was due to limitations of sample size and suboptimal adherence and was potentially attributable to the lesser degree of hypoxia in non-PAP users compared with PAP users. Residual hypoxia despite treatment may provide a potential explanation for the worse COVID-19 outcomes and could be the potential reason for poor outcomes reported in patients with treated SDB.

[colomom]

A couple more important points to consider about the study:

“The study backdrop was controversy over whether to continue positive-airway pressure (PAP) treatment for sleep-disordered breathing because of concern over virus aerosols.”

“The authors called for interventional studies to determine whether early, effective PAP or supplemental oxygen use in patients with high hypoxic physiological stress at night improves COVID-19 outcomes…If sleep-related hypoxia indeed translates to worse COVID-19 outcomes, risk stratification strategies should be implemented to prioritize early allocation of COVID-19 therapy to this subgroup of patients.”
https://www.cidrap.umn.edu/news-perspec ... 9-outcomes

On a personal note, my sister-in-laws husband just tested positive for COVID. He was vaccinated as is she, but I worry about how my SIL will do if he passed the COVID onto her considering she has severe OSA and has to use both PAP and O2 at night. Currently in Colorado 1/3 of COVID cases are breakthroughs and 20% of COVID hospitalizations are people who are fully vaccinated. Because Colorado hospitals are full they are deploying buses across the state to deliver monoclonal antibody treatments. I welcome this study and hope that if my SIL tests positive for COVID it gives her a good argument to make to the docs that she is in a high risk category and should be eligible for the monoclonal antibody treatment. I also can’t understand how the CDC decided people with depression are at high risk of negative outcomes with COVID, but those of us with OSA aren’t eligible for boosts.

Take the study as you will, but at the very least I hope it inspires those of you who haven’t yet gotten your boosters to get it done.

[ChicagoGranny]

but those of us with OSA aren’t eligible for boosts.

In my territory, people who use CPAP are going to major pharmacy chains and saying they use CPAP and are vulnerable to COVID. The chains give them boosters without questions. There are plenty of vaccines available. The damn problem here is the low vaccination rate in the rural areas.

For instance, you can schedule an appointment for a booster using CVS online system. Check the box that says "need an extra dose due to weakened immune system". Get an appointment, and no questions are asked when you show up for the jab. The pharmacies are happy to give the shots when the supply is plentiful. Isn't it the case that everyone who has sleep apnea has a weakened immune system? Even if only a tiny bit weakened.

[chunkyfrog]

Politics often control supply and distribution.
Nebraska's governor unilaterally threw out health conditions as a factor in
allocating the first vaccines, and went strictly by AGE.
My sleep doc used his position to set up a separate vac event for all his patients.
(I knew he was special.)

[babydinosnoreless]

Whoever wants my booster can have it I was so sick from the first shot I will NOT do that again until they get it like the flu vaccine where it doesn't make anyone sick anymore. My thyroid is still inflamed from it and it was something like 6 -8 months ago. No thanks !