High-risk obstructive sleep apnea is related to longer hospital stay in COVID-19 patients

Abstract

BACKGROUND AND AIM: Obstructive sleep apnea (OSA), having an increased inflammatory state due to an imbalance between sympathetic and parasympathetic activity, intermittent hypoxia, and increased cytokines, may aggravate the immune response for COVID-19 infection. Our aim was to evaluate the effect of OSA upon inflammatory response and length of stay in patients with favorable outcomes. METHODS: Patients admitted to an outpatient clinic after being hospitalized for treatment of COVID-19 were included consecutively in this cross-sectional multicenter observational study. STOP-Bang Questionnaire and a cut-off value of 3 points were used to identify patients with a high risk of OSA. RESULTS: Study population consisted of 201 patients with a median STOP-Bang score of 2.0 (1.0-4.0) points. According to the cut-off value of 3 points, 94 (46.8%) patients were classified as high-risk OSA patients. High-risk OSA patients were older, had many comorbidities such as hypertension, coronary artery disease, and diabetes mellitus, had higher serum D-dimer, ferritin, C-reactive protein, and procalcitonin measurements, and had a longer hospital stay. Possible risk factors associated with length of stay were age, lymphocyte count, and total STOP-Bang score. Multivariable analysis revealed that a 1 point increase in STOP-Bang score results in a 0.43 day longer hospital stay. CONCLUSIONS: Prevalence of OSA within COVID-19 patients with favorable outcomes is similar to the general population. However, the length of stay is related to the presence of high-risk OSA. Our study, therefore, suggests that OSA is related to delayed improvement of COVID-19 infection.