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Association of Sleep-Related Hypoxia With Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System.
Pena Orbea, Cinthya; Wang, Lu; Shah, Vaishal; Jehi, Lara; Milinovich, Alex; Foldvary-Schaefer, Nancy; Chung, Mina K; Mashaqi, Saif; Aboussouan, Loutfi; Seidel, Kelsey; Mehra, Reena.
  • Pena Orbea C; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Wang L; Quantitative Health Science Department, Cleveland Clinic, Cleveland, Ohio.
  • Shah V; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Jehi L; Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Milinovich A; Quantitative Health Science Department, Cleveland Clinic, Cleveland, Ohio.
  • Foldvary-Schaefer N; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Chung MK; Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
  • Mashaqi S; Department of Pulmonary, Critical Care and Sleep Medicine, University of Arizona School of Medicine, Tucson.
  • Aboussouan L; Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
  • Seidel K; Respiratory Institute, Heart and Vascular Institute and Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
  • Mehra R; Department of Pharmacy Practice, Northeast Ohio Medical University, Rootstown.
JAMA Netw Open ; 4(11): e2134241, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1508587
ABSTRACT
Importance The influence of sleep-disordered breathing (SDB) and sleep-related hypoxemia in SARS-CoV-2 viral infection and COVID-19 outcomes remains unknown. Controversy exists regarding whether to continue treatment for SDB with positive airway pressure given concern for aerosolization with limited data to inform professional society recommendations.

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. Design, Setting, and

Participants:

This case-control study was conducted within the Cleveland Clinic Health System (Ohio and Florida) and included all patients who were tested for COVID-19 between March 8 and November 30, 2020, and who had an available sleep study record. Sleep indices and SARS-CoV-2 positivity were assessed with overlap propensity score weighting, and COVID-19 clinical outcomes were assessed using the institutional registry. Exposures Sleep study-identified SDB (defined by frequency of apneas and hypopneas using the Apnea-Hypopnea Index [AHI]) and sleep-related hypoxemia (percentage of total sleep time at <90% oxygen saturation [TST <90]). Main Outcomes and

Measures:

Outcomes were SARS-CoV-2 infection and WHO-designated COVID-19 clinical outcomes (hospitalization, use of supplemental oxygen, noninvasive ventilation, mechanical ventilation or extracorporeal membrane oxygenation, and death).

Results:

Of 350 710 individuals tested for SARS-CoV-2, 5402 (mean [SD] age, 56.4 [14.5] years; 3005 women [55.6%]) had a prior sleep study, of whom 1935 (35.8%) tested positive for SARS-CoV-2. Of the 5402 participants, 1696 were Black (31.4%), 3259 were White (60.3%), and 822 were of other race or ethnicity (15.2%). Patients who were positive vs negative for SARS-CoV-2 had a higher AHI score (median, 16.2 events/h [IQR, 6.1-39.5 events/h] vs 13.6 events/h [IQR, 5.5-33.6 events/h]; P < .001) and increased TST <90 (median, 1.8% sleep time [IQR, 0.10%-12.8% sleep time] vs 1.4% sleep time [IQR, 0.10%-10.8% sleep time]; P = .02). After overlap propensity score-weighted logistic regression, no SDB measures were associated with SARS-CoV-2 positivity. Median TST <90 was associated with the WHO-designated COVID-19 ordinal clinical outcome scale (adjusted odds ratio, 1.39; 95% CI, 1.10-1.74; P = .005). Time-to-event analyses showed sleep-related hypoxia associated with a 31% higher rate of hospitalization and mortality (adjusted hazard ratio, 1.31; 95% CI, 1.08-1.57; P = .005). Conclusions and Relevance In this case-control study, SDB and sleep-related hypoxia were not associated with increased SARS-CoV-2 positivity; however, once patients were infected with SARS-CoV-2, sleep-related hypoxia was an associated risk factor for detrimental COVID-19 outcomes.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Sleep Apnea Syndromes / Severity of Illness Index / Cause of Death / COVID-19 / Hospitalization Subject: Sleep Apnea Syndromes / Severity of Illness Index / Cause of Death / COVID-19 / Hospitalization Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: JAMA Netw Open Clinical aspect: Etiology Year: 2021

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Sleep Apnea Syndromes / Severity of Illness Index / Cause of Death / COVID-19 / Hospitalization Subject: Sleep Apnea Syndromes / Severity of Illness Index / Cause of Death / COVID-19 / Hospitalization Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: JAMA Netw Open Clinical aspect: Etiology Year: 2021
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