Obstructive sleep apnoea phenotypes in adults with a history of COVID-19 infection

Abstract

An association between COVID-19 and obstructive sleep apnoea (OSA) has been reported in the literature. Understanding the phenotypic characteristics of OSA in patients with a history of COVID-19 infection is important for the management of treatment strategies for both OSA and long-term effects of COVID-19 (Long COVID). This was a case-control study; the case group consisted of individuals who had a COVID-19 infection (n=152) and the control group were chosen among the sleep clinic cohort without a history of COVID-19 infection (n=152). Both groups were individually matched for age, sex and body mass index. The prevalence of OSA, defined as an apnoea-hypopnoea index [AHI] ≥15/h was significantly lower in the case group (50.0%) compared to the sleep clinic group (77.6%) (p<0.001). Notwithstanding, 36 cases (47.4%) exhibited REM-predominant (PD) OSA (defined as a total AHI of ≥15/h and REM-AHI /non-REM-AHI ≥2), while only 21 controls (17.8%) had this phenotype (p<0.001). In a multiple logistic regression analysis, there was a significant correlation between a history of COVID-19 and the occurrence of REM-PD OSA (Odds ratio [OR] 3.14; 95% confidence interval [CI] 1.89-5.25; p<0.001). Fatigue, reported as "frequent/very frequent," was observed in 52.8% of patients with REM-PD OSA and 35.7% of patients without REM-PD OSA (p=0.033). Factors associated with fatigue were female sex (OR 2.02; 95% CI 1.12-3.64, p=0.019) and REM-PD OSA (OR 2.18; 95% CI 1.29-3.69; p=0.004). To conclude, REM-PD OSA is common among individuals with a history of COVID-19 infection, which is significantly related with fatigue. Thus, it is important to consider REM-PD OSA in adults with Long-COVID to better manage both conditions.