Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severityis unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severityand the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity – based on hospital or intensive care unit (ICU) admission and the number of days of hospitalization – were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. OnlyLSAT was found to be significantly associated with the COVID-19 severity (p&lt;0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA – based on AHI, ODI, and RDI – and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission and the number of days of hospitalization.<br>

阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea, OSA）本身及其危险因素均被证实与2019冠状病毒病（Coronavirus Disease 2019, COVID-19）的预后存在关联。然而，OSA严重程度与COVID-19病情严重程度之间的关联仍不明确。本研究旨在评估临床评估OSA严重程度的相关参数以及OSA治疗类型是否与COVID-19病情严重程度存在关联。
本研究回顾了2020年3月至12月期间，伊萨拉医院（Isala Hospital）门诊及住院的确诊COVID-19的OSA患者的临床资料，收集了患者基线数据、睡眠监测参数、OSA治疗相关信息以及住院相关数据。
本研究选取呼吸暂停低通气指数（Apnea Hypopnea Index, AHI）、最低血氧饱和度（Low oxyhemoglobin desaturation, LSAT）、氧减指数（Oxygen Desaturation Index, ODI）、呼吸紊乱指数（Respiratory Disturbance Index, RDI）以及OSA治疗类型作为自变量，以患者是否住院/入住重症监护病房（Intensive Care Unit, ICU）及住院时长作为COVID-19病情严重程度的结局变量。
采用多项回归分析、二元logistic回归分析以及零膨胀负二项回归分析，评估OSA严重程度评估参数与COVID-19病情严重程度之间的关联。
本研究共纳入137例患者。当将COVID-19病情严重程度二分为非住院组与住院/ICU收治/死亡组时，仅LSAT与COVID-19病情严重程度存在显著相关性（p<0.05）。因此，本研究结果显示，LSAT或是COVID-19病情严重程度的显著危险因素。不过，若以住院/ICU收治情况及住院时长作为评估指标，基于AHI、ODI及RDI的OSA严重程度以及OSA治疗方式均未被证实为COVID-19病情严重程度的危险因素。