Sleep Disorders

Sleep-Disordered Breathing and COVID-19

Sleep-Disordered Breathing and COVID-19 Hospitalizations and Mortality in Adult Patients (N = 1935)


ECMO = extracorporeal membrane oxygenation, TST = total sleep time

The association was assessed of polysomnographically identified sleep-disordered breathing (SDB) and sleep-related hypoxia with SARS-CoV-2 positivity and WHO-7 COVID-19 clinical outcomes while accounting for potential confounding influences including obesity, underlying cardiopulmonary disease, cancer, and smoking history. This was a retrospective cohort examination of a large institutional registry. Sleep study-identified SDB was defined by frequency of apneas and hypopneas (apnea hypopnea index, AHI) and sleep-related hypoxemia (percentage of sleep time < 90% SaO2, TST< 90). WHO-7 COVID-19 clinical outcomes include hospitalization, use of supplemental oxygen, noninvasive ventilation, mechanical ventilation/extracorporeal membrane oxygenation (ECMO), and death among those with SDB. The median TST< 90% was significantly associated with WHO-7 COVID-19 ordinal scale (adjusted OR = 1.39, 95% CI: 1.10-1.74, P = 0.005). Time to event analyses showed that those patients with sleep-related hypoxia defined by greater TST < 90 (> 1.8%) had a 31% higher risk of hospitalization and mortality than those with smaller TST < 90 (≤ 1.8%), HR 1.31, 95% CI: 1.08-1.57, P = 0.005. Sleep-related hypoxia portends detrimental COVID-19 outcomes.

Pediatric Sleep-Disordered Breathing and COVID-19 Clinical Outcomes (N = 123)


AHI = apnea hypopnea index

A retrospective review of 123 consecutive patients (< 18 years) with prior polysomnogram (PSG) and COVID-19 testing from Cleveland Clinic's COVID-19 registry was conducted. Obstructive sleep apnea (OSA) was not associated with increased SARS-CoV-2 positivity: 1.20 (0.1, 3.47, P = 0.74). No significant difference between cases and controls for median AHI 2.8 (1.2, 5.6) vs 3.2 (1.5, 6.1), P = 0.64, SpO2 nadir 89.5 ± 0.5 vs 88.4 ± 6.3, P = 0.30, %time SpO2 < 90%, P = 0.29, respectively, was noted. WHO-7 COVID-19 clinical outcomes did not meet statistical significance in relation to OSA due to the low event frequency. Of note, those with OSA vs without OSA had a higher WHO-7 outcome score of 2 vs 0 and prevalence of hospitalization: 13.3% vs 0%, respectively. Of hospitalized patients, the following was observed: 23% had moderate/severe OSA vs 4.3% mild OSA, 50% required supplemental oxygen, and 25% required intubation/invasive ventilation. No deaths or readmissions were reported. High risk conditions included 75% obesity, 50% asthma, 25% sickle cell disease, and 25% hypoplastic left heart.