The 2019 coronavirus (COVID-19) global pandemic had a significant impact on the diagnosis and treatment of obstructive sleep apnea (OSA). These results of a systematic review were published in Sleep Medicine Reviews.
Researchers at Warwick Medical School in the UK searched publication databases for articles on COVID-19 and sleep by June 2, 2020. For this review, studies (N = 18) that contained data on OSA were analyzed. Of the papers, 10 related to the diagnosis, treatment and management of OSA with COVID-19 and 8 related to OSA and the risk of COVID-19 mortality.
The most common mortality risks from COVID-19 in patients with OSA were advanced age, high body mass index, high blood pressure, cardiovascular disease, lung disease, and diabetes. A study on diabetes and COVID-19 identified OSA as an independent predictor of an increased risk of mortality on day 7 (odds ratio) [OR]2.80; 95% CI, 1.46-5.38).
Some evidence suggests that the cytokine storm that occurs in the most severely ill COVID-19 patients may be made worse by hypoxemia. The attacks of disturbed breathing during sleep in patients with OSA cause hypercapnia and hypoxemia, which can worsen cytokine storm symptoms in patients with COVID-19 and OSA.
Other possible molecular or biological mechanisms that put patients with OSA at particular risk for worse COVID-19 outcomes include oxidative stress and inflammation, which are pathways activated in OSA. Other mechanisms include vitamin D levels, which are lower in people with OSA, and high blood pressure and idiopathic pulmonary fibrosis, which are common with OSA.
One aspect of the COVID-19 pandemic that is particularly relevant and affects people with OSA and their families is the transmission of the virus. COVID-19 is mainly transmitted through droplets. Continuous Positive Airway Pressure (CPAP) machines that patients with OSA sleep on are a droplet-generating process that may make the virus worse.
Some researchers have argued that CPAP should be avoided during the pandemic. However, discontinuation of treatment was associated with a return of negative symptoms. The most recently published guidelines recommended that patients continue to use their CPAP machine but, if possible, separate from their partners and maintain a high standard of hygiene for their machine.
The pandemic has likely affected the diagnosis of OSA and other sleep conditions as many sleep clinics have suspended or reduced appointment volumes. The study’s authors recommended increasing the use of telemedicine for sleep-related problems and home testing.
The limitations of the underlying studies discussed in this review included non-systematic designs (n = 6), small sample sizes (n = 4), descriptive data (n = 1), and data collected in a single center were (n = 1). .
The review authors concluded that patients with OSA were at increased risk for poorer clinical outcomes of COVID-19 infection due to comorbidities and the mechanistic pathways of OSA. The disease has likely been underdiagnosed recently, which is likely to have implications for the health of future patients. Research is needed to develop sanitary diagnostic methods and determine which molecular pathways place patients with OSA at higher risk for COVID-19 mortality.
Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnea. Sleep Med Rev. 2020; 55: 101382. doi: 10.1016 / j.smrv.2020.101382
This article originally appeared on Psychiatry Advisor