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 the severity of COVID-19 is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and 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 results, 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. The severity of COVID-19 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 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. Multivariate analyses showed that there was no significant association between AHI, LSAT, ODI, RDI, or the type of OSA treatment and hospital or ICU admission for COVID-19, and also not with number of days of hospitalization (p>0.05). Although previous studies found OSA to be a risk factor for COVID-19, our findings showed that the degree of OSA and OSA treatment were not significantly associated with the severity of COVID-19 when looking at hospital or ICU admission and the number of days of hospitalization.