Submitted by Susan Redline, MD, MPH. Professor of Sleep Medicine, Brigham and Women’s Hospital and Harvard Medical School

As many people are aware, obesity, high blood pressure and diabetes are associated with more severe Covid-19 infections. However, an important question is whether sleep apnea is an unrecognized or hidden risk factor for complications from Covid-19 and whether positive airway pressure (PAP), used to treat sleep apnea, changes this risk.

Our team asked this question by analyzing a large database of patients seen at Mass Gen Brigham Health System from the greater Boston area.

What did we find? We found that among patients with Covid-19 infection, patients with sleep apnea were more likely to die (11.9%) compared to those without sleep apnea (6.9%). After accounting for group differences in age, sex and race, sleep apnea was associated with about a 70% increased risk for death. It is important to note, that the link between sleep and death only was seen in patients not treated with PAP in the prior year (before their infection). COVID-19 positive patients with sleep apnea who used CPAP in the prior year did not have a higher risk of death compared to COVID-19 patients without sleep apnea.

What do these findings mean? Untreated sleep apnea is a risk factor for Covid-19 related death, and patients with sleep apnea who contract the novel coronavirus should be followed closely. The study also suggests that CPAP use may reduce the risk of death among patients with sleep apnea with Covid-19.

Study limitations: Information on sleep apnea diagnosis and CPAP use were based on electronic medical record data. Since sleep apnea is under-diagnosed, it is possible that some of those classified “no sleep apnea” actually had sleep apnea. Also, the amount of CPAP use was not known. Future studies should look at whether more CPAP use is more protective than less use among patients with sleep apnea and Covid-19.

Bottom line: While everyone should follow public health guidelines to avoid Covid-19 infection (mask wearing, social distancing, and hand washing), these recommendations are especially important for people with sleep apnea. There are many benefits to using CPAP treatment – this study provides one more reason for patients with sleep apnea to work with their health care providers to make sure that their sleep apnea is well treated.

This study was recently published in the American Journal of Respiratory and Critical Care Medicine.

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