Sleep-related hypoxia increases the odds of hospitalizations including mortality in Covid-19 patients, according to a retrospective study reported in JAMA Network Open.¹

The study examined 350,710 persons who had been tested for Covid-19 at the Cleveland Clinic Health System. Of these, 5402 individuals, aged 56 years (average), had taken a sleep study and were included in the current study. Women constituted 56% of the study population; the average BMI of the participants ranged from 34 to 36. Many of them also had comorbidities including hypertension, asthma, or diabetes. 1935 of these 5402 persons later on tested positive for Covid-19 by RT PCR.

Analysis of data showed more severe COVID-19 clinical outcomes, including hospitalization and mortality in Covid-19 patients with sleep-related hypoxia (average total sleep time (TST) with an oxygen saturation less than 90%). This association persisted even after adjusting for other factors such as heart disease, cancer, smoking status. But, no association of sleep-disordered breathing with an increased risk for acquiring SARS-CoV-2 and testing positive for Covid-19.

This study shows that although baseline sleep apnea does not increase the risk of acquiring Covid-19, if present, it enhances the inflammatory process and may worsen outcomes once the patient develops the infection. It is hypothesized that sleep-related hypoxia augments the hypoxia in Covid-19 patients and thus intensifies the hypoxia-related injury. Hence, sleep-related hypoxia may be considered as a risk factor for severe Covid-19. However, the study does not shed light on if oxygen supplementation or positive airway pressure (PAP) for sleep apnea would improve the outcomes and the authors suggest it as an area for further research.

Reference

1. Pena Orbea C, et al. Association of sleep-related hypoxia with risk of COVID-19 hospitalizations and mortality in a large integrated health system. JAMA Netw Open. 2021; DOI:10.1001/jamanetworkopen.2021.34241