Sleep Apnea & The Increased Risk of COVID

Summary

  • The CDC has reported that the death rate for patients who did not have any other comorbidity was 0.9% compared to as much as 10.5% for those with other health problems.
  • Two case studies of patients with diagnosed COVID-19 and those who were admitted to the ICU revealed that OSA was present in about 21% and 29% of patients, respectively.
  • If it is left untreated, OSA can lead to various other health conditions such as headaches, hypertension, stroke, diabetes, etc. so if OSA is not diagnosed appropriately, it can detract you from the right treatment.
  • The CPAP devices used by the OSA patients can be a source of carrying the pandemic-causing virus deep into their lungs, potentially quadrupling their propensity of being infected and developing complications.
  • Caribbean-born blacks were more predisposed to the development of sleep apnea than the US-born blacks.
  • More effort should be made to screen propensity of sleep apnea in the Caribbean to aid early detection and treatment to prevent the associated conditions and complications.

With the emergence of the contagious COVID-19, everyone, including young, old, sick, and healthy people were at risk of contracting the infection. However, old age and pre-existing health disorders like lung ailments, diabetes, hypertension, cardiovascular disease, or other comorbidities, exponentiated the risk of infection and its associated complications. Since the novel virus mechanisms are widely under extensive research, scientists are investigating whether obstructive sleep apnea (OSA) is another condition that adds to the increased risk of COVID-19. [1]

The CDC has reported that the mortality rate of patients who did not have any comorbidity was about 0.9% compared to 10.5% for those with other health complications. Two case studies of patients with diagnosed COVID-19 and those who were admitted to the ICU revealed that OSA was present in about 21% and 29% of patients, respectively. [2, 3]

Furthermore, a report published in the Journal of Clinical Sleep Medicine highlights that critical cases of COVID-19 patients having an underlying OSA may potentially suffer from the worsening shortage of oxygen and the cytokine storm associated with COVID. [4]

Herein, we will discuss why patients with OSA are at an increased risk of COVID, why it is critical to know if you suffer from sleep apnea and the predisposition of OSA in people from the Caribbean.

Why is it Important to Know if You Have Sleep Apnea?

Sleep apnea is associated with troubled breathing during sleep, which ends up disrupting your sleep numerous times throughout the night. If left untreated, this condition can lead to various other health complications such as headaches, hypertension, stroke, diabetes, etc.

Suppose you’re already suffering from any of the associated conditions and an undiagnosed case of sleep apnea. In that case, you might go for the wrong treatment that will not only worsen your sleep apnea but also won’t improve your symptoms. Thus, it is vital to identify if you suffer from sleep apnea in order to undertake appropriate treatment modalities.

Treatment options vary according to the type of sleep apnea and the severity of the associated symptoms. Continuous positive airway pressure (CPAP) that comprises of a mask, is used while you sleep along with dental and nasal devices. It may also be accompanied by symptomatic therapy to treat the condition. [5]

How Does Having Sleep Apnea Increase the Risk for COVID And Any Complications?

Unlike the common cold or flu that begins with the nose and throat, targeting the upper respiratory tract, coronavirus infects the lower airways. It predominantly affects the cells below the voice box, penetrating deep into the lungs. This can happen through inhalation of air, swallowing of saliva into the throat, and aspiration of fluid from the nose. While aspiration is a normal phenomenon during sleeping, aspiration of fluids contaminated with bacteria and microorganisms can lead to pneumonia, particularly in older patients.

Additionally, seeking the right treatment for Sleep Apnea will improve sleep quality and serve as the first approach to a stronger immune system that will prevent colds, flu, and infection.

Likewise, it is essential to keep good hygiene when using CPAP devices. Cleaning the devices regularly will heavily decrease contamination and propensity for the virus for the OSA patient and others in the home. [6] Learn about CPAP Cleaner VirtuClean 2.0

Propensity from People in The Caribbean to Have Sleep Apnea

OSA is a common sleep disorder that excessively affects the black population, but there is negligible research in the Caribbean about this condition. A study on a total of 554 patients with 55% of women showed that people with routine snoring, excessive daytime sleepiness, and sleep disintegration were at high risk of OSA. The incidence of OSA symptoms was: snoring 45%, excessive daytime sleepiness 33%, and difficulty maintaining sleep 34%. 47% also reported falling asleep while driving (14%) and watching television (47%). A history of cardiovascular diseases was the vital predictor of the propensity of expression of OSA symptoms. [7]

Another study reported that a significant number of Haitians had sleep apnea symptoms with difficulty breathing at night as a strong analyst of a history of heart disease. Excessive daytime sleepiness was also more prevalent among medical students in Haiti (73.7% of the participants).

Previously, it was also found that Caribbean-born blacks were more predisposed to sleep apnea development than US-born blacks. [8] It is suggested that more effort should be made to screen propensity of sleep apnea in the Caribbean and investigate whether Caribbean-born blacks are more likely to develop OSA than African Americans and whites. This will lead to early detection and treatment to prevent the associated conditions and complications.

References

  1. Tufik S, Gozal D, Ishikura IA, Pires GN, Andersen ML. Does obstructive sleep apnea lead to an increased risk of COVID-19 infection and severity? J Clin Sleep Med. Published online May 22, 2020. doi:10.5664/jcsm.8596
  2. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. COVID-19 in critically ill patients in the Seattle region – case series. N Engl J Med. 2020;382(21):2012-2022.
  3. Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323(16):1612-1614.
  4. McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med. Published online May 1, 2020. doi:10.5664/jcsm.8538
  5. Anonymous. (Aug 2017). 6 Signs You Have Sleep Apnea. Geisinger. https://www.geisinger.org/health-and-wellness/wellness-articles/2017/08/24/14/35/6-signs-you-have-sleep-apnea#:~:text=%22Recognizing%20the%20type%20of%20sleep,stroke%20and%20even%20traffic%20accidents.%22
  6. Rosenberg C. Coronavirus Concerns for Patients with Sleep Apnea. Sleep health solutions. April 2020. https://www.sleephealthsolutionsohio.com/blog/coronavirus-sleep-apnea-cpap-therapy/
  7. Zizi F, Jean-Louis G, Fernandez S, von Gizycki H, Lazar JM, Nunes J, Brown CD. Symptoms of obstructive sleep apnea in a Caribbean sample. Sleep Breath. 2008 Nov;12(4):317-22. doi: 10.1007/s11325-008-0190-x. Epub 2008 May 31. PMID: 18516637.
  8. Rosenthal DM, Conserve DF, Severe D, et al. Sleep Apnea Symptoms and Cardiovascular Disease Risks among Haitian Medical Students. J Sleep Disord Ther. 2017;6(2):264. doi:10.4172/2167-0277.1000264
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