Study Explores the Relationship Between COVID-19 Outcomes and OSA

An African-American man wearing cpap mask while laying in bed
Do patients with COVID-19 and obstructive sleep apnea have a worse prognosis than those without OSA?

Patients with COVID-19 who have obstructive sleep apnea (OSA) have higher mortality and hospital lengths of stay than COVID-19 patients without OSA. Additionally, rates of OSA were found to be similar in patients presenting to the emergency department with and without COVID-19. These were among results of a study of the relationship between OSA and COVID-19 published in the journal Sleep and Breathing.    

The current study was conducted at the 2 sites in The Netherlands. The researchers sought to compare the prevalence of OSA in patients with and without SARS-CoV-2 infection who were admitted to the same hospital during the same period of time. They also evaluated the effect of OSA on clinical outcomes associated with COVID-19 infection. The study was conducted during the peak of the “first wave” of the COVID-19 pandemic in The Netherlands — between March 1, 2020, and May 16, 2020. During this time, all individuals presenting to the ED with any sign of COVID-19 were routinely tested by nasopharyngeal swab for the presence of SARS-CoV-2 infection.

A total of 1884 patients presenting to the ED were enrolled in the study, 723 who were diagnosed with COVID-19 and 1161 who presented with respiratory symptoms but tested negative for COVID-19. The prevalence of OSA did not differ between the 2 groups (6.8% in the COVID-positive arm vs 5.7% in the COVID-negative arm; P =.230). In the COVID-positive arm, however, the mortality rate was higher among those who also had OSA vs  those without OSA (34.7% vs 21.2%, respectively; P =.028). Notably, the increased risk for mortality among patients with comorbid COVID-19 and OSA was independent of body mass index, age, male gender, cardiovascular disease, diabetes, and obstructive lung disease.

Besides having higher rates of mortality, the percentage of patients admitted to the intensive care unit was higher in the COVID-positive OSA group vs the COVID-positive non-OSA group (24.5% vs 13.9%, respectively; P =.044). Similarly, the COVID-positive OSA group also experienced longer hospital lengths of stay (12.6±15.7 days vs 9.6±9.9 days, respectively; P =.049).

The findings from this study demonstrate that OSA should be included in COVID-19 risk factor analyses, said investigators. Clinicians need to be aware of the relationship between OSA and COVID-19 outcomes, they noted, adding that the mechanism underlying this relationship warrants additional exploration.

Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.


Voncken SFJ, Feron TMH, Laven SAJS, et al. Impact of obstructive sleep apnea on clinical outcomes in patients hospitalized with COVID-19. Sleep Breath. Published online September 24, 2021. doi:10.1007/s11325-021-02476-z