Sleep Apnea Is Prevalent After Intensive Care Unit Stay for COVID-19 Pneumonia

Those who recovered from SARS-CoV-2 pneumonia in the intensive care unit (ICU) have a high prevalence of sleep apnea (SA) 3 months after their ICU stay, according to study findings published in the journal Nature and Science of Sleep.

Using data collected in a French single-center observational cohort study (COV-RECUP; ClinicalTrials.gov identifier: NCT04519320), investigators assessed 68 patients who had recovered from COVID-19-related pneumonia 3 months after leaving the ICU to determine the prevalence of SA as well as variations in patients’ apnea-hypopnea index (AHI). Among study participants, 91% (62 of 68) had known comorbidities (hypertension in 34, obesity in 21, dyslipidemia in 20, and type 2 diabetes in 16) and 19.1% (13 of 68) has preexisting SA.

In this study, a prospective cohort of patients in the ICU for severe COVID-19 infection took part in a comprehensive follow-up program 3 months after the onset of their symptoms. Follow-up included home polygraphy as well as pulmonary function tests, 6-minute walk tests, and chest computed tomography (CT) scans. Patients with an AHI of 5 or greater were classified as having SA.

The investigators found that at 3 months, 91% (62 of 68) of participants had SA, with 85.5% of these individuals experiencing obstructive events. No SA or mild SA (AHI of <15) was observed in 24 participants, and 44 patients reported moderate to severe SA (AHI of ≥15). The presence of ischemic heart disease affected those in the moderate to severe SA arm exclusively. Notably, the investigators found that symptoms of COVID-19 had been mostly more severe in the participants with moderate to severe SA, who had required a longer curarization, more prone positioning sessions, and more frequent administration of tracheostomy.

Several limitations of the present study should be noted. The results might have had more power if study recruitment was of a larger population from several different centers, along with the use of a centralized, double-blind interpretation of the polygraphy findings. Additionally, there was no long-term follow-up of sleep disturbances identified in the study.

“Our study highlights the high prevalence of SA three months after an ICU stay for COVID-19, which deserves systemic screening,” study authors concluded. However, they added, “SA shares common risk factors with severe COVID-19 infection, but is underdiagnosed, and therefore might have only been diagnosed after hospitalization for COVID-19.” The researchers further noted that the high frequency of SA might be partly attributable to mechanical ventilation and/or neuromuscular blocking agents received in the ICU.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.