Association of Obstructive Sleep Apnea with Mechanical Ventilation in Hospitalized SARS-CoV-2 Patients

ABSTRACT

RATIONALE The literature about respiratory outcomes in coronavirus disease 2019 (COVID-19) is continuously growing. The relation between severe COVID-19 and other risk factors shared in patients with obstructive sleep apnea (OSA) is well documented. However, data related to OSA as an independent risk factor for severe COVID-19 remains limited. The aim of this study is to assess whether OSA is associated with a higher risk of mechanical ventilation (MV) compared to non-OSA individuals in hospitalized COVID-19 patients. METHODS A retrospective cohort study was conducted at Hôpital Maisonneuve-Rosemont (Montreal, Canada). All COVID-19 adult patients admitted from March 1st to June 30th 2020 were included. Data on demographic characteristics, comorbidities, treatment, ICU admission and mortality were collected from electronic medical records. To evaluate the association between OSA and MV requirement, a multivariable logistic regression analysis was performed including known risk factors for severe COVID-19 disease. RESULTS Out of 697 patients included in this study, 43 (6.2%) were found to have OSA. The risk of MV requirement was statistically higher in the OSA group compared to the non-OSA group (18.6% [n=8] vs 9.0% [n=59], p=0.039). Multivariate logistic regression analysis showed that OSA was an independent risk factor for MV requirement when adjusted for age, sex, diabetes, chronic obstructive pulmonary disease, moderate to severe chronic renal disease, solid tumor malignancies, myocardial infarction and dementia (adjusted odds ratio 2.70 ;95% CI 1.13-6.46, p=0.047). CONCLUSION OSA is independently associated with an increased risk of MV requirement among hospitalized patients affected by SARS-CoV2. This study emphasizes the need for OSA to be recognized as a high-risk medical condition in patients with SARS-CoV2 and warrants measures, such as OSA screening and increased in-hospital monitoring, to prevent lifethreatening complications. Further research must be done to understand the link between OSA and severe COVID-19.