With so much still unknown about COVID-19, what we do know to be true is that patients with certain underlying health conditions like obesity, diabetes and hypertension, are at greater risk for negative medical outcomes. A health condition that may be making its way onto this list is obstructive sleep apnea (OSA).
A new study from the University of Warwick undertook a comprehensive review of the medical and scientific studies of COVID-19 and OSA. As of June 2020, there have been eighteen studies regarding COVID-19 and sleep apnea. Ten of these studies were related to the diagnosis, treatment, and management of sleep apnea, and the other eight focused on the death risk from COVID-19. The findings show a relationship between COVID-19 and OSA in three major areas:
There is a mounting body of evidence to suggest that people afflicted with OSA may also be at increased risk for negative outcomes from COVID-19: Data was collected from studies with reported outcomes from patients with COVID-19 that were also diagnosed with sleep apnea.
One of these studies focused on diabetic patients who were hospitalized due to COVID-19. The study showed that patients being treated for obstructive sleep apnea had a
2.8 times greater risk of death on day seven of hospitalization. Overall, the studies suggest that many patients that were admitted to the intensive care unit (ICU) also had OSA.
Another study done in Finland, which is awaiting peer review, had a similar finding. The study found that of the 28 patients that were admitted to Turku University Hospital for COVID-19, 29 percent of them had been previously diagnosed with OSA
A problem that arises for researchers collecting accurate data for these studies is that many cases of OSA go undiagnosed. In the United States alone, 20 percent of adults suffer from sleep apnea, and an estimated 90 percent of these cases are undiagnosed. Not only is this a problem for the researchers, but also a concern for the general population, regardless of COVID-19, since OSA can lead to serious health conditions all on its own.
In the same study at Turku University, all patients admitted to the hospital with COVID-19 symptoms were tested for "C-reactive protein," which measures inflammation. The patients whose conditions worsened requiring admission to the ICU, had a higher level of C-reactive protein, than those patients admitted to the hospital, but did not require intensive care. The C-reactive protein is also used as a biomarker for the diagnosis of OSA. This study also indicated patients who had lower oxygen saturation upon admission, also a symptom of OSA, were more likely to need to be admitted into the ICU.
The lead author of the University of Warwick study. Dr. Michelle Miller, states that COVID-19 likely increases inflammation and oxidative stress and has effects on what researches call the "bradykinin pathways." Researchers were alerted to the potential link to OSA, since these are the same pathways that are affected in patients who suffer from OSA. Dr. Miller suggested that it would not be surprising that COVID-19 affects these mechanisms even more strongly.
These findings show that there can be a common physiological response to both COVID-19 and OSA.
Because of the similarity in the body's reaction to COVID-19 and OSA, health professionals began to treat COVID-19 patients with Continuous Positive Airway Pressure, or CPAP therapy. The use of a CPAP machine is the primary treatment for OSA, where the constant pressure generated by the machine holds the airways open while the patient sleeps. This is to prevent soft tissues from collapsing and
obstructing the airway so air can move freely into and out of the lungs. CPAP is now showing to be promising as an early intervention for those with respiratory
symptoms, including shortness of breath and low oxygen saturation, in patients with COVID-19.
Initially, CPAP machines were avoided because of fear of putting healthcare workers and family members at risk because the virus would be spread through particles aerosolized by the CPAP machine. The benefits appear to outweigh the risk, when proper precautions are taken. In the UK, safety guidelines have been established by the British Sleep Society and the OSA alliance, regarding the coronavirus and OSA. In the U.S., many healthcare facilities have their own safety guidelines to follow regarding CPAP use for COVID-19 patients.
If you have COVID-19 and use a CPAP machine for sleep apnea:
● Continue to use your CPAP as directed.
● If you live with others, try to isolate yourself while using your CPAP
● Maintain a clean-air environment in your bedroom
● Do not touch your face (especially your eyes, nose, or mouth) with dirty hands
● Clean your CPAP mask and hose daily, and frequently change the filters in your machine
● Do not share CPAP equipment.
● Always check with your doctor if you symptoms or conditions change.
If you are admitted to the hospital and have COVID-19:
● Bring your own CPAP machine if possible.
● Do not use your machine without notifying hospital staff.
● Do not use your humidifier without speaking with hospital staff beforehand, due to the increased droplets with COVID-19.
Here are some tips on remaining safe if you have OSA:
● Stay educated on how the virus spreads so that you know how to protect yourself. With so much to learn about the novel coronavirus, new information is coming out frequently; stay up-to-date.
● Wash your hands with soap and water for at least 20 seconds every time you have been in a public place, came into contact with someone else, you cough or sneeze, etc.
● Carry sanitizer with you for when soap is not available.
● Do not touch your face (especially your eyes, nose, or mouth) with dirty hands.
● Avoid contact with others and practice social distancing.
● Wear a mask when you are around others.
● Take care of yourself and your immune system by eating healthy foods and moving your body regularly.
The first step is to get tested, and have the test results interpreted by a physician who specializes in sleep. Fortunately, with advances in telemedicine and testing technology, these sleep tests can be performed right in your own home. Learn more about the home sleep test for OSA.
© 2020 American Sleep Association.