Obstructive Sleep Apnea Linked With Higher Risk of COVID-19 Hospitalization, Complications

January 18, 2021
Matthew Gavidia
Matthew Gavidia

Matthew is an associate editor of The American Journal of Managed Care® (AJMC®). He has been working on AJMC® since 2019 after receiving his Bachelor's degree at Rutgers University–New Brunswick in journalism and economics.

Obstructive sleep apnea was identified as an independent risk factor for severe coronavirus disease 2019 (COVID-19) resulting in hospitalization.

Obstructive sleep apnea (OSA) was identified as an independent risk factor for severe coronavirus disease 2019 (COVID-19) resulting in hospitalization, according to study findings published last week in BMJ Open Respiratory Research.

As a result of researchers examining at-risk populations amid the pandemic, OSA has been identified as a potentially prominent factor contributing to COVID-19 hospitalization. C-reactive protein and procalcitonin were significantly higher in patients who were eventually transferred to critical care units compared with those who were not.

Moreover, the researchers of the present study highlight that OSA is associated with several known risk factors linked with severe COVID-19: body mass index (BMI), diabetes, older age, and male gender.

“Such risk would have substantial effect as OSA is a common disease affecting at least 8% of the population, with higher prevalence in older age groups reaching to over 20% in individuals over 60 years of age,” noted the study authors.

Examining patients who participated in the FinnGen study (N = 260,405), the researchers sought to investigate whether OSA is a risk factor for COVID-19 infection or for severe COVID-19, defined by requirement of hospitalization, independent of these potential risk factors: age, sex, BMI, hypertension, type 1 and type 2 diabetes, coronary heart disease, asthma, and chronic obstructive pulmonary disease.

Association was assessed via multivariate logistic regression model, with comorbidities for either COVID-19 or OSA selected as covariates. The researchers also performed a meta-analysis with previous studies, analyzing the association between OSA and severe COVID-19.

In the analysis, 445 patients (37.3% male; mean age, 52.7 years) with COVID-19 were identified, 38 of whom had diagnosed OSA (8.5%; 50% male; mean age, 61.3 years).

“This reflects a similar prevalence of OSA diagnoses in COVID-19–infected [individuals] as in the normal population in FinnGen, where prevalence is 8%,” noted the researchers.

Of the patients requiring hospitalization for severe COVID-19 (n = 91; 36.3% male; mean age, 65.9 years), more than 1 in 5 had OSA (n = 19; 20.9%), which was shown to be associated with COVID-19 hospitalization independent from age, sex, BMI, and comorbidities. However, there was no significant difference in risk for contracting COVID-19 between patients with OSA and those without.

The meta-analysis also showed that among 15,835 control patients with COVID-19, the patients who had OSA and severe cases of COVID-19 (n = 1294) had more than double the risk of hospitalization (odds ratio, 2.37; 95% CI, 1.14-4.95; P = .021).

“We believe that our finding may help in identifying high-risk individuals for severe forms of COVID-19 infection, and therefore screening for previous indications of OSA could be beneficial among individuals testing positive for the virus,” concluded the researchers.


Strausz S, Kiiskinen T, Broberg M, et al. Sleep apnoea is a risk factor for severe COVID-19. BMJ Open Resp Res. Published online January 12, 2021. doi:10.1136/bmjresp-2020-000845