LONG COVID WP1 – Perger E. et al
LONG COVID WP1 – Studio della prevalenza dei fattori di rischio cv attraverso la raccolta di informazioni dei pazienti al basale e dopo 3-6 mesi di follow-up
SLEEP-DISORDERED BREATHING AMONG HOSPITALIZED PATIENTS WITH COVID-19
Coronavirus disease (COVID-19) has severely affected healthcare systems all over the world. Although age, hypertension, cardiovascular diseases, lung diseases, and diabetes mellitus seem to represent the main risk factors for worse outcomes in COVID-19 (1), a possible role has also been ascribed to sleep-disordered breathing (SDB) (2–4). A recent preliminary study collecting questionnaire data in a case series of COVID-19 pneumonia showed that 25% of patients presented a history of SDB (5). It has been hypothesized that SDB might predispose patients to COVID-19 severe pneumonia and that the coexistence of these two respiratory conditions might worsen patients’ prognosis (2, 4).
In the days of pandemic outbreak, we sought to correlate the presence and severity of SDB with COVID-19 outcomes during hospitalization. Despite the dramatic situation we were experiencing, which prevented us from optimizing the standardization of examinations, such as the sleep apnea test (SAT), we managed to include patients with spontaneous breathing for SDB evaluation.
Our screened sample included 93 subjects. Among them, 39 did not perform the SAT, as they were using 24-hour NIV because of COVID-19–related respiratory failure. Out of the total 44 patients who underwent the SAT, 13 were on oxygen treatment. Two subjects were treated with nocturnal continuous positive airway pressure owing to their previous history of obstructive sleep apnea (OSA) and were included in the study.
The proportion of SDB presence in our sample was 75% (95% CI, 60–87%).
To our knowledge, this is the first evaluation of SAT in patients hospitalized for COVID-19. Almost two-thirds of our sample had SDB, and OSA severity predicted respiratory outcome. Several mechanisms may contribute to the increased risk of severe COVID-19 in patients with OSA (6). Even though obesity confirms an established relation with OSA (4), our findings highlight that higher obstructive AHI is also associated with the need of NIV or invasive ventilation, even after controlling for age and BMI.
Systemic inflammation is a pathophysiologic feature shared by both COVID-19 and OSA. OSA-related intermittent hypoxia and fragmented sleep determine a proinflammatory status that may enhance the typical COVID-19 cytokine storm, thus worsening disease evolution.
The possible role of SDB treatment in prognosis improvement of patients hospitalized for COVID-19 needs to be further investigated through properly sized intervention studies.
Reference: Perger E, Soranna D, Pengo M, Meriggi P, Lombardi C, Parati G. Sleep-disordered Breathing among Hospitalized Patients with COVID-19. Am J Respir Crit Care Med. 2021;203(2):239-41. Epub 2020/11/13. doi: 10.1164/rccm.202010-3886LE. PubMed PMID: 33180549; PubMed Central PMCID: PMCPMC7874403.