Sleep apnea and chronic illness increase long-term Covid risk

CNN
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Adults who suffer from obstructive sleep apnea have up to a 75% increased risk, on average, of developing long Covid after SARS-CoV-2 infection compared to people without sleep apnea, according to a new report. study.

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

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

A second analysis of medical records from a small group of 330,000 adults found the risk was just 12%, according to the study, which is part of RECOVER, or Researching Covid to Enhance Recovery. RECOVER is an initiative of the National Institutes of Health dedicated to understanding why some people develop long Covid and how to better detect, treat and prevent the disease.

Why the huge difference in numbers? People in the larger study had additional health conditions or comorbidities, such as obesity, diabetes, high blood pressure and heart disease, said study lead author Lorna Thorpe. , co-lead of 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 different levels of comorbidities, but also different definitions of long Covid,” she said. “We didn’t even have a working definition for long Covid until October 2021.

“I think the risk is probably in the middle, but we’ll need more studies to sort it out,” added Thorpe, professor and chair of the division of epidemiology at NYU Grossman School of Medicine.

A third analysis of the medical records of 102,000 children with sleep apnea found no correlation between sleep apnea and the long Covid after the various mix-ups health conditions were considered, “which, of course, is great news,” Thorpe said.

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

This is an “important study” into the long Covid, said Dr Sairam Parthasarathy, senior researcher at Arizona University of Health Sciences RECOVER Adult Study and Professor of Medicine.

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

“It is important to note that some of the symptoms of long Covid, such as fatigue, may be linked to obstructive sleep apnea, and that treating obstructive sleep apnea may improve these long Covid symptoms” , he added.

The study, published Thursday in the journal Sleep, is one of several published since Congress has allocated $1.15 billion at the NIH in January 2021, to study the long-term effects of Covid over a four-year period. To date, the agency claims to have used approximately $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 poorer outcomes after Covid infection.

“People with sleep apnea are at higher risk of more severe cases of Covid-19, hospital intensive care admission and death,” Thorpe said.

“Obstructive sleep apnea can lead to increased inflammation, potentially disrupted sleep leading to an increased propensity to develop infections and reduced immunity,” said Dr. Bhanu Prakash Kolla, sleep medicine specialist at the Center for Sleep Medicine. from the Mayo Clinic in Rochester, Minnesota.

“This could potentially explain the pathway by which obstructive sleep apnea leads to an increased risk of having Covid and also … (long 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 that 80% of patients with obstructive sleep apnea (OSA) are undiagnosed,” he said. Additionally, “one assumption of these analyzes is that patients with OSA are amenable to treatment. However, almost half of them do not use the treatment.

Why would women have up to 89% more risk compared to 59% for men? The study did not address this issue.

However, “one can posit that this difference may be based on what we know about sex differences in sleep and immune responses,” said 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 first published studies on the link between sleep apnea and serious Covid infection.

“Women generally have stronger immune responses to viral infections, and therefore also a vulnerability to post-infection inflammation,” Zee said. “Women in general have more insomnia and with long Covid tend to have symptoms of fatigue and insomnia, which are also common symptoms of long Covid.”

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

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

As scientists learn more about the long Covid, more information will become available, Thorpe said. In the meantime, people who suffer from sleep apnea – or who snore, snort and stop breathing at night, all of which are signs of the disease – should be extra careful when contacting Covid.

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