COVID Tied to New Sleep Apnea Diagnosis Up to More Than 4 Years Later

A new study suggests a link between SARS-CoV-2 infection and the development of obstructive sleep apnea (OSA), even years after the initial illness. Researchers found a modest increase in risk for both those hospitalized with COVID-19 and those who contracted the virus without requiring hospitalization.

Increased Risk After COVID-19

The retrospective study, based on data from March 2020 to August 2024, indicated that individuals hospitalized with a positive COVID-19 test had a 41% higher risk of developing new-onset OSA compared to those who remained uninfected. Those infected without hospitalization experienced a 22% elevated risk. These findings were reported by Tim Q. Duong, PhD, of Montefiore Medical Center in New York City, and colleagues in a preprint on medRxiv.

Why This Matters

The researchers emphasize the importance of increased awareness among clinicians regarding OSA in patients recovering from COVID-19, particularly those with pre-existing risk factors or a history of hospitalization. Untreated OSA carries significant risks, including cardiovascular and cognitive complications, making early detection and intervention crucial.

Did You Know? The study analysed data from 910,393 adults tested for SARS-CoV-2 infection using PCR testing.

Prior research has established that pre-existing OSA can worsen outcomes from COVID-19. A separate study also revealed a higher likelihood of both COVID-19 and influenza diagnoses in children with OSA.

The Potential Connection

The study authors suggest a plausible biological link between COVID-19 and OSA. OSA can stem from anatomical factors, obesity, and issues with neuromuscular control of the airway. SARS-CoV-2 infection, particularly in moderate to severe cases, may exacerbate these vulnerabilities.

The virus has been associated with persistent systemic inflammation, autonomic dysregulation, and effects on the central nervous system – all factors that can disrupt sleep and breathing regulation. Prolonged immobilization during severe COVID-19 hospitalizations, corticosteroid use, and weight gain are all known risk factors for OSA. Even less severe cases of COVID-19, leading to what is known as Long COVID, may impair respiratory function and sleep patterns.

Expert Insight: The findings underscore the potential for long-term health consequences following a COVID-19 infection, extending beyond the acute respiratory illness. This highlights the need for comprehensive post-COVID care that considers potential impacts on sleep and respiratory health.

The researchers also conducted a sensitivity analysis using a pre-pandemic control cohort of 621,046 individuals from 2016-2019, yielding similar results. Vaccination status did not appear to influence the risk of developing OSA.

Long-Term Health Implications

Patients hospitalized with COVID-19 who subsequently developed OSA exhibited higher risks of incident heart failure (risk ratio [RR] 2.33) and pulmonary hypertension (RR 1.98). Non-hospitalized COVID-19 patients with new-onset OSA had a higher risk of obesity (RR 1.16) compared to those who remained COVID-negative.

The study did acknowledge some limitations. The data included only patients who returned to the Montefiore Health System for follow-up care, potentially introducing bias toward more severe cases. Reliance on PCR testing alone could have resulted in some COVID-19 cases being misclassified.

Frequently Asked Questions

What is obstructive sleep apnea?

OSA arises from anatomical factors, obesity-related airway narrowing, impaired neuromuscular control, altered ventilatory control, and systemic inflammation, according to the researchers.

How long after a COVID-19 infection was the risk of OSA observed?

The study observed a risk of developing OSA up to 4.5 years after the initial SARS-CoV-2 infection.

Did vaccination status affect the risk of developing OSA?

No, vaccination status did not significantly correlate with the risk of new-onset OSA in this study.

Given these findings, what further steps might be taken to understand and address the potential link between COVID-19 and OSA?