1. Association of Sleep-Related Hypoxia With Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System
- Author
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Alex Milinovich, Vaishal Shah, Loutfi S. Aboussouan, Lara Jehi, Lu Wang, Cinthya Pena Orbea, Mina K. Chung, Nancy Foldvary-Schaefer, Kelsey Seidel, Saif Mashaqi, and Reena Mehra
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Polysomnography ,Severity of Illness Index ,Hypoxemia ,Extracorporeal Membrane Oxygenation ,Sleep Apnea Syndromes ,Risk Factors ,Cause of Death ,Internal medicine ,Severity of illness ,Positive airway pressure ,Odds Ratio ,Pulmonary Medicine ,medicine ,Humans ,Hospital Mortality ,Continuous positive airway pressure ,Sleep study ,Risk factor ,Hypoxia ,Aged ,Ohio ,Original Investigation ,Cardiopulmonary disease ,Continuous Positive Airway Pressure ,medicine.diagnostic_test ,Delivery of Health Care, Integrated ,SARS-CoV-2 ,business.industry ,Research ,COVID-19 ,General Medicine ,Middle Aged ,Respiration, Artificial ,respiratory tract diseases ,Hospitalization ,Online Only ,Logistic Models ,Case-Control Studies ,Florida ,Female ,medicine.symptom ,Sleep ,business - Abstract
Key Points Question Are sleep-disordered breathing and sleep-related hypoxia associated with SARS-CoV-2 infection and COVID-19 outcomes? Findings In this case-control study of 5402 patients in a large integrated health system, sleep-disordered breathing and sleep-related hypoxia were not associated with an increased likelihood of contracting SARS-CoV-2. After accounting for confounding factors including cardiopulmonary disease, cancer, and smoking exposure, sleep-related hypoxia indices were associated with more severe COVID-19 clinical outcomes, including hospitalization and mortality, in time-to-event analyses. Meaning These results suggest that baseline sleep-related hypoxia may portend worse clinical prognosis in COVID-19., This case-control study investigates the association of sleep-disordered breathing and sleep-related hypoxia with SARS-CoV-2 infection and COVID-19 outcomes., Importance The influence of sleep-disordered breathing (SDB) and sleep-related hypoxemia in SARS-CoV-2 viral infection and COVID-19 outcomes remains unknown. Controversy exists regarding whether to continue treatment for SDB with positive airway pressure given concern for aerosolization with limited data to inform professional society recommendations. Objective To investigate the association of SDB (identified via polysomnogram) and sleep-related hypoxia with (1) SARS-CoV-2 positivity and (2) World Health Organization (WHO)-designated COVID-19 clinical outcomes while accounting for confounding including obesity, underlying cardiopulmonary disease, cancer, and smoking history. Design, Setting, and Participants This case-control study was conducted within the Cleveland Clinic Health System (Ohio and Florida) and included all patients who were tested for COVID-19 between March 8 and November 30, 2020, and who had an available sleep study record. Sleep indices and SARS-CoV-2 positivity were assessed with overlap propensity score weighting, and COVID-19 clinical outcomes were assessed using the institutional registry. Exposures Sleep study–identified SDB (defined by frequency of apneas and hypopneas using the Apnea-Hypopnea Index [AHI]) and sleep-related hypoxemia (percentage of total sleep time at
- Published
- 2021
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