Prevalence of COVID -19 prevalence in obstructive sleep apnea syndrome and clinical prognosis of disease

Öz

Objective: In this study, we aimed to investigate the demographic and polysomnographic characteristics of our obstructive sleep apnea (OSA) patients who diagnosed by polysomnography and who had a novel coronovirus disease (COVID-19) due to SARS-CoV-2. In addition we also aimed to evaluate whether sleep apnea syndrome is a risk factor for COVID-19. Method: The medical records of 287 patients diagnosed with obstructive sleep apnea syndrome (OSAS) by polysomnography between the years 2018-2019 were accessed by obtaining their permissions by telemedicine method. Demographic characteristics, polysomnographic parameters, comorbid diseases, obesity states and hospitalization rates due to COVID-19 were statistically evaluated. Results: Thirty-two patient’s (11.1%) COVID-19 polymerase chain reaction (PCR) were positive. The mean age of OSAS patients with COVID-19 was 50.4±10.9, 78% were male, 71.9% had a body mass index above 30. The most common comorbidity in OSAS patients with and without COVID-19 was hypertension. Eighteen of thirty-two patients who had COVID-19 had severe OSAS. Polysomnographic parameters evaluation revealed that there was no statisticaly difference between apnea hypopnea index, oxygen desaturation index, mean and minimum oxygen saturations between two groups who had COVID-19 and had not. Five of our cases with COVID-19 were hospitalized and one patient needed intensive care unit. Conclusion: Although OSAS has a strong association with major comorbidities for severe COVID-19, its effects on hypoxia, decreased sleep time, impaired immunity and cytokine storm suggest OSAS as an independent risk factor.

Anahtar Kelimeler

• Obstructive sleep apnea syndrome
• Covid-19
• oxidative stress
• immunity

Obstrüktif uyku apne sendromu tanılı hastalarımızda COVID-19 prevelansı ve hastalığın klinik seyri

Öz

Amaç: Bu çalışmada polisomnografik olarak obstrüktif uyku apne sendromu (OUAS) tanısı konulan hastalarımızdan SARS-CoV-2’ ye bağlı yeni koronovirüs hastalığı (COVID-19) geçirenlerin, demografik ve polisomnografik özelliklerini incelemeyi, uyku apne sendromunun COVID-19 için risk faktörü oluşturma durumunu değerlendirmeyi amaçladık. Yöntem: Çalışmada 2018-2019 yıllları içinde polisomnografi ile OUAS tanısı konulan 287 hastanın, Tele-tıp yöntemi ile izinleri alınarak dosyalarına ulaşıldı. Bu hastaların demografik özellikleri, polisomnografik parametreleri, ek hastalık ve obezite varlığı, COVID-19 pozitif ise hastalık nedeni ile hastaneye yatış oranları istatistiksel olarak değerlendirildi. Bulgular: Otuz iki (%11.1) hastanın COVID-19 polimeraz zincir reaksiyonu (PCR) testi pozitifti. COVID-19 geçiren OUAS hastalarının yaş ortalaması 50.4±10.9’dı. Olguların %78’i erkekti, %71.9’unun vücut kitle indeksi 30’un üzerindeydi. COVID-19 olan ve olmayan OUAS’lı hastalarda en sık görülen ek hastalık hipertansiyondu. COVID-19 geçiren 32 hastanın 18’inin ağır dereceli OUAS’ı vardı. Uykuda solunum parametreleri değerlendirildiğinde COVID-19 geçirenler ile geçirmeyenler arasında apne hipopne indeksi, oksijen desaturasyon indeksi, ortalama ve minumum oksijen saturasyonları arasında istatistiksel olarak fark yoktu. COVID-19 geçiren beş olgu hospitalize edilmiş, bir olgunun yoğun bakım ihtiyacı olmuştu. Sonuç: OUAS’ın şiddetli COVID-19 hastalığı ile ilişkili olan majör komorbiditeler ile kuvvetli ilişkisi bulunmakla birlikte hastalığa eşlik eden hipoksi, uyku süresinin azalması ile immünite zayıflaması ve sitokin fırtınasına olan etkisi OUAS’ın bu komorbiditelerden bağımsız olarak da şiddetli COVID-19 için bir risk faktörü olabileceğini düşündürmektedir.

Anahtar Kelimeler

• Covid-19
• obstruktif uyku apne sendromu
• oksidatif stres
• immünite

Kaynakça

1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30;:]. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5.
2. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032.
3. WHO Coronavirus (COVID-19) Dashboard. Erişim: 10 Mayıs 2021. https://covid19.who.int/
4. Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198. Published 2020 Mar 26. doi:10.1136/bmj.m1198
5. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, et al .Estimation of the global prevalence and burden of obstructive sleep apnoea: aliterature-based analysis. Lancet RespirMed. 2019;7(8):687–698.
6. Pinto JA, Ribeiro DK, Cavallini AF, Duarte C, Freitas GS. Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study. Int Arch Otorhinolaryngol. 2016;20(2):145-150. doi:10.1055/s-0036-1579546
7. Irwin MR, Opp MR. Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology. 2017;42(1):129-155. doi:10.1038/npp.2016.148.
8. The AASM Manual for the Scoring of Sleep and Associated Events – Rules, Terminology and Technical Specifications Version 2.5. USA, 2018.

9. Dünya Sağlık Örgütü Covid-19 Durum Raporları. Erişim Yeri: https://covid19.who.int/. Erişim Tarihi: 10 Mayıs 2021.
10. Sağlık Bakanlığı Covid-19 Durum Raporları. Erişim Yeri: https://covid19.saglik.gov.tr/. Erişim Tarihi: 10 Mayıs 2021.
11. Amerika Birleşik Devletleri Oregon Universitesi, Louca Laboratuavarı, Covid 19 Raporları. Erişi Yeri:loucalab.com/archive/COVİD19prevalance. Erişim Tarihi: 10 Mayıs 2021.
12. Lévy P, Kohler M, McNicholas WT, et al. Obstructive sleep apnoea syndrome. Nat Rev Dis Primers. 2015;1:15015. Published 2015 Jun 25. doi:10.1038/nrdp.2015.15.
13. Redline S, Kump K, Tishler PV, Browner I, Ferrette V. Gender differences in sleep disordered breathing in a community-based sample. Am J Respir Crit Care Med. 1994;149(3 Pt 1):722-726. doi:10.1164/ajrccm.149.3.8118642.
14. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017.
15. Jaillon S, Berthenet K, Garlanda C. Sexual Dimorphism in Innate Immunity. Clin Rev Allergy Immunol. 2019;56(3):308-321. doi:10.1007/s12016-017-8648-x.
16. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. doi:10.1111/all.14238.
17. Simonnet A, Chetboun M, Poissy J, et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation [published correction appears in Obesity (Silver Spring). 2020 Oct;28(10):1994]. Obesity (Silver Spring). 2020;28(7):1195-1199. doi:10.1002/oby.22831.
18. Heymsfield SB, Wadden TA. Mechanisms, Pathophysiology, and Management of Obesity. N Engl J Med. 2017;376(3):254-266. doi:10.1056/NEJMra1514009.
19. McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med. 2020;16(9):1645. doi:10.5664/jcsm.8538.
20. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052.
21. Barceló A, Elorza MA, Barbé F, Santos C, Mayoralas LR, Agusti AG. Angiotensin converting enzyme in patients with sleep apnoea syndrome: plasma activity and gene polymorphisms. Eur Respir J. 2001;17(4):728-732. doi:10.1183/09031936.01.17407280.
22. Cariou B, Hadjadj S, Wargny M, et al. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study [published correction appears in Diabetologia. 2020 Jul 2;:]. Diabetologia. 2020;63(8):1500-1515. doi:10.1007/s00125-020-05180-x.
23. Strausz S, Kiiskinen T, Broberg M, et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Respir Res. 2021;8(1):e000845. doi:10.1136/bmjresp-2020-000845.
24. Voulgaris A, Ferini-Strambi L, Steiropoulos P. Sleep medicine and COVID-19. Has a new era begun?. Sleep Med. 2020;73:170-176. doi:10.1016/j.sleep.2020.07.010.
25. Thorpy M, Figuera-Losada M, Ahmed I, et al. Management of sleep apnea in New York City during the COVID-19 pandemic. Sleep Med. 2020;74:86-90. doi:10.1016/j.sleep.2020.07.013.
26. Maas MB, Kim M, Malkani RG, Abbott SM, Zee PC. Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure. Sleep Breath. 2021;25(2):1155-1157. doi:10.1007/s11325-020-02203-0.