Obstructive Sleep Apnea Increase Risk of Long COVID in Adults

Lorna Thorpe, PhD, MPH

Credit: NYU Langone Health

According to a new study led by the National Institutes of Health (NIH) RECOVER Initiative, obstructive sleep apnea may significantly increase the risk of long COVID in adults. The study analyzed data from 3 RECOVER research networks of patients who had tested positive for COVID-19 between March 2020 and February 2022.¹

"This study is the first collaboration of this focus and scale to find that adults with sleep apnea are at greater risk for long COVID,” lead investigator Lorna Thorpe, PhD, MPH, a professor and director of the Division of Epidemiology at NYU Langone Health said in a statement.

The networks included 1 pediatric-focused network (PEDSnet) with more than 100K children and 2 adult networks. The National Patient-Centered Clinical Research Network (PCORnet) included 330,000 adult patients; the National COVID Cohort Collaborative (N3C) consisted of 1.7 million adult patients.

Results demonstrated patients with a prior diagnosis of obstructive sleep apnea exhibited a 12% increased risk for long-term symptoms of COVID-19 for up to months after their initial infections. The importance of these findings was emphasized by the condition’s prevalence (1 in 8 adults) as well as the underdiagnosis of obstructive sleep apnea.

"There's still so much to uncover about long COVID, but this study will inform clinical care by identifying patients that should be watched more closely," corresponding investigator Hannah Mandel, a senior research scientist for the electronic health record studies arm of the RECOVER CSC at NYU Langone Health said in the statement.

Individuals experiencing long COVID may show symptoms such as brain fog, fatigue, depression, and sleep problems, according to the statement. It also noted that previous evidence has indicated patients with obstructive sleep apnea are susceptible to more severe illness when initially infected with COVID-19.

"People with sleep apnea who get infected with COVID should seek early treatment, pay attention to their symptoms, and keep up with their vaccinations to lower the risk of infection in the first place,” Mandel said.

The team of investigators believed the variances in the percentage increases of long COVID risk between the study groups would be a result of the differences in how long COVID is defined, the populations studied, and the methods used to analyze patient records across the extensive research.

However, the data displayed obstructive sleep apnea as a contributing factor to long COVID risk in adults and this association disappeared in children after adjusting for risk factors such as obesity.

"A strength of the work is that the link between sleep apnea and long COVID persisted regardless of how the researchers in our study defined long COVID or gathered data,” Thorpe said.

In the National COVID Cohort Collaborative (N3C) patient group, investigators found obstructive sleep apnea was associated with a 75% increased likelihood of long COVID compared with those without sleep apnea.

Results from the N3C study revealed women with obstructive sleep apnea had a higher risk of long COVID when compared with men affected by obstructive sleep apnea. Specifically, women had an 89% increased probability of experiencing long COVID, while men exhibited an increased likelihood of 59%.

The study did not investigate the cause behind these gender differences but the possibility that women with documented sleep apnea in their medical history may have more severe conditions than men was acknowledged, particularly because women with sleep apnea show a tendency toward living with undiagnosed obstructive sleep apnea for a longer period of time.

References:

1. Sleep Apnea Associated with Increased Risk for Long COVID. NYU Langone Health. Published May 11, 2023.
   https://prnmedia.prnewswire.com/news-releases/sleep-apnea-associated-with-increased-risk-for-long-covid-301822379.html