Sleep apnea and a chronic condition raise long Covid risk


A new study has found that adults who have obstructive sleep apnea have an average 75% increased risk of developing chronic COVID after SARS-CoV-2 infection compared to those without sleep apnea.

According to an analysis of electronic health data on nearly 1.8 million people, women with obstructive sleep apnea had an increased risk of up to 89%, while men had a 59% higher risk.

Obstructive sleep apnea is a potentially dangerous disorder in which breathing stops for about 10 seconds several times during the night due to obstruction of the airway by heavy or relaxed soft tissue in the mouth and throat.

A second analysis of medical records of a smaller group of 330,000 adults found the risk to be only 12%, according to the study, which is part of the Recovery or Research Covid to Increase Recovery. RECOVER is a National Institutes of Health initiative dedicated to understanding why some people develop chronic COVID-19 and how best to detect, treat and prevent the condition.

Why the huge difference in numbers? Senior study author Lorna Thorpe said people in the larger study had additional health concerns, or comorbidities such as obesity, diabetes, high blood pressure and heart disease. Co-leads the RECOVER Clinical Science Core at NYU Langone Health.

“The range of 12% to 75% is likely due to a combination of different study populations and varying levels of co-morbidity, but also different definitions of chronic Covid,” she said. “Until October 2021, we didn’t even have a working definition for Long COVID.

“I believe the risk is likely intermediate, but we will need additional studies to tease this out,” said Thorpe, professor and director of the department of epidemiology at NYU Grossman School of Medicine.

A third analysis of the medical records of 102,000 children with sleep apnea found no association between sleep apnea and chronic Covid. “Health conditions were taken into account,” Thorpe said, “which is certainly good news.”

“By using three very large networks of electronic health records, we were able to perform this study three times, which is one of the strengths of the research,” she said. “This study is the first collaboration of this focus and scale to find that adults with sleep apnea are at greater risk for chronic Covid.”

This is a “significant study” on chronic COVID, Dr. Sairam Parthasarathy, A principal investigator at Arizona Health Sciences University Professor of Recovering Adult Studies and Medicine.

Parthasarathy, who was not involved in the study, said, “Research needs to be done in a prospective study to verify this association, and if these findings hold true, the implications of these findings on long-term Covid treatment.” Does matter.”

“It is important to note that some symptoms of prolonged Covid such as fatigue may be related to obstructive sleep apnea, and treatment of obstructive sleep apnea may improve such prolonged Covid-related symptoms,” he said.

The study, published Thursday in the journal Sleep, is one of many published since then. Congress allocated $1.15 billion NIH in January 2021, to study the long term effects of Covid over a period of four years. To date, the agency says it has used about $811 million To fund research.

The researchers wanted to investigate the role of sleep apnea in long COVID because of the well-known association between the condition and poor outcomes following a COVID infection.

“People with sleep apnea are at higher risk for more severe cases of COVID-19, hospitalizations in intensive care, and mortality,” Thorpe said.

“Obstructive sleep apnea can result in increased inflammation, potentially increasing the propensity to develop obstructive sleep infections and reduced immunity,” Dr. Bhanu Prakash Kolla is a sleep medicine specialist in the Center for Sleep Medicine at the Mayo Clinic in Rochester, Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea increases the risk of COVID as well as … (longer COVID),” said Kolla, who was not involved in the study.

Sleep apnea is an underdiagnosed condition, regardless of gender, said Parthasarathy of the University of Arizona.

“It is conservatively estimated 80% patients Obstructive sleep apnea (OSA) is not diagnosed,” he added. Furthermore, “one assumption made with these analyzes is that patients with OSA are likely to be treated. however, about half of them Not using treatment.

Why would there be an 89% higher risk in women compared to 59% in men? The study did not address that issue.

However, “based on what we know about sex differences in sleep and immune responses, this difference may be accounted for,” Dr. Phyllis Zee, director of the Center for Circadian and Sleep Medicine at Northwestern University Feinberg School of Medicine in Chicago.

Zee, who was not involved in the new research, co-authored one of the previously published studies On the association between sleep apnea and severe COVID infection.

“Women generally have a stronger immune response to viral infections, and thus also have a vulnerability to post-infection inflammation,” Xie said. “Women in general have more insomnia, and longer COVID-19 symptoms tend to present with fatigue and insomnia, which are also common symptoms of prolonged COVID-19.”

Another reason may be that sleep apnea has historically been considered a male disease, Thorpe said, which may mean that by the time a woman is diagnosed, her apnea is more advanced.

“It may be that women who are documented in electronic health records have more severe sleep apnea because physicians often look for sleep apnea among men,” she said.

Thorpe said that as scientists learn more about Long Covid, further information will become available. In the meantime, people who have sleep apnea – or those who snore, snore and stop breathing at night, which are all symptoms of the condition – should exercise extreme caution when exposed to Covid.

“People with sleep apnea who become infected with COVID should seek early treatment and consider taking the prescribed oral medication paxlovid to reduce the risk of serious consequences,” Thorpe said. “They should also keep up with their vaccinations to reduce their risk of infection in the first place.”

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