Sleep Disorders Could Raise the Risk of Severe COVID-19

Nov. 15, 2021 — People with insomnia are no more likely than other adults to contract the coronavirus and develop COVID-19. However, if they are infected, they have a 31% higher risk of being hospitalized or dying from the disease, new research shows.

Investigators looked at nearly 360,000 patients tested for COVID-19 in the Cleveland Clinic’s system. This group included 5,400 people who also completed a sleep study.

They also considered other factors that could alter COVID-19 risk, including obesity, heart and lung disease, cancer and smoking.

The study was published on November 10 in JAMA network open.

When asked if she was surprised by the 31% increased risk,

Cinthya Pena Orbea, MD,

says: “While this was consistent with ours one (existing) hypotheses and we were careful to account for lung disease and smoking history, we still found a statistically significant association.”

Pena Orbea is a Fellow of the Sleep Disorder Center and an Assistant Professor of Medicine at the Cleveland Clinic Lerner College of Medicine.

The study is important because it helps identify another group at potential risk for worse outcomes from COVID-19 and can help direct assets and resources where they are needed, said senior study author Reena Mehra, MD. director of sleep disorders research at the Cleveland Clinic, in a press release.

“As the COVID-19 pandemic continues and disease remains highly variable from patient to patient, improving our ability to predict who will have more severe disease is critical,” she said.

The study can help doctors adapt. “Should a patient with sleep apnea develop a COVID19 infection, they may need to be prioritized or triaged to receive anti-COVID therapies, which have been in short supply at times,” Indira Gurubhagavatula, MD, MPH, chair of the American Academy of Sleep Medicine COVID -19 Task Force says.

Exact mechanism a mystery

Why people with sleep disorders can develop more severe COVID-19 remains unknown, but inflammation may play a role, Mehra noted.

Gurubhagavatula says that makes sense.

“We know that people who develop severe COVID-19 infection appear to do so because of a ‘cytokine storm,’ which is an overwhelming inflammatory burden that leads to injury to organs, including lung tissue,” she says.

“We also know that sleep apnea itself causes increased inflammation,” says Gurubhagavatula.

However, previous studies seem to agree that inflammation may be the key. For example, other researchers have linked low blood oxygen levels to signs of inflammation, including higher white blood cell counts, in people with COVID-19.

It could also have direct effects on the lungs.

Next Steps

The research also offers important clues on how to move forward in treating the large population of patients suffering from sleep apnea who develop COVID-19 infection, says Gurubhagavatula.

Some of the unanswered questions include: Should we encourage patients receiving CPAP to make full use of their devices to limit their risk of developing worse outcomes from COVID-19? Should we prioritize obstructive sleep apnea patients who develop COVID-19 over therapies for the infection?

Pena Orbea and colleagues plan to continue this research.

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