Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2021; 14(03): 299-302
DOI: 10.5935/1984-0063.20200078
THEORETICAL ESSAYS

Is there a link between COVID-19 and obstructive sleep apnea?

Cristina Salles
1   Escola Bahiana de Medicina e Saúde Pública, Pesquisa - Salvador - Bahia - Brazil
,
Juliana Rodrigues Lopes
1   Escola Bahiana de Medicina e Saúde Pública, Pesquisa - Salvador - Bahia - Brazil
,
Margarida Neves
2   Universidade Federal da Bahia - Salvador - Bahia - Brazil.
,
Renata Silva Brito
1   Escola Bahiana de Medicina e Saúde Pública, Pesquisa - Salvador - Bahia - Brazil
,
Andrea Bacelar
3   Brazilian Sleep Association, President - Rio de Janeiro - Rio de Janeiro - Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

ABSTRACT

Although obstructive sleep apnea syndrome (OSAS) is not considered a risk factor for COVID-19, studies have observed that these two conditions have comorbidities in common such as diabetes, cardiovascular diseases, asthma, obesity, hypertension, and chronic obstructive pulmonary disease. Thus, one may question the possible contribution of OSAS to the worsening of hypoxemia in patients with COVID-19 since OSAS and obesity (hypoventilation) are associated with hypoxemia, which can be a worsening factor in the hypoxemia of COVID-19 pneumonia. Moreover, one may question whether sleep deprivation would negatively interfere with the pulmonary condition caused by COVID-19. Another question would be whether sleep deprivation resulting from OSAS would be a favorable condition for the pulmonary inflammatory process in patients with COVID-19. Studies with a more significant number of participants are needed to assess the possible impact of OSAS on the outcomes of patients with SARS-CoV-2 infection, providing a more solid basis for making therapeutic decisions. An important advance in understanding the influence of OSAS on COVID-19 is represented by careful identification of comorbidities and potential pathophysiological mechanisms that may contribute to the favorable outcome of these patients.

Keywords:

Coronavirus Infections - Obstructive Sleep Apnea - Sleep


Publication History

Received: 22 July 2020

Accepted: 02 December 2020

Article published online:
30 November 2023

© 2021. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Centers for Disease Control and Prevention (CDC). Information for healthcare professionals about coronavirus (COVID-19) [Internet]. Atlanta: CDC; 2019. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html
  • 2 Sharma A, Tiwari S, Deb MK, Marty JL. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2): a global pandemic and treatment strategies. Int J Antimicrob Agents [Internet]. 2020 Jun; 56(2):106054. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0924857920302247
  • 3 Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in weight and nutritional habits in adults with obesity during the “lockdown” period caused by the COVID-19 virus emergency. Nutrients. 2020 Jul;12(7):2016.
  • 4 Ministério da Saúde (BR). Secretaria Nacional de Ações Básicas de Saúde. Estatísticas de mortalidade. Brasília (DF): Ministério da Saúde; 2000.
  • 5 Asher MI. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J. 1998 Aug;12(2):315-35.
  • 6 Tantisira KG, Weiss ST. Complex interactions in complex traits: obesity and asthma. Thorax. 2001 Sep;56(Suppl 2):ii64-73.
  • 7 Mello ED, Luft VC, Meyer F. Childhood obesity - towards effectiveness. J Pediatr (Rio J). 2004;80(3):173-82.
  • 8 Figueroa-Muñoz JI, Chinn S, Rona RJ. Association between obesity and asthma in 4-11 year old children in the UK. Thorax. 2001 Feb;56(2):133-7.
  • 9 Lopez-Jimenez F, Kuniyoshi FHS, Gami A, Somers VK. Obstructive sleep apnea: implications for cardiac and vascular disease. Chest. 2008 Mar;133(3):793-804.
  • 10 Imagawa S, Yamaguchi Y, Ogawa K, Obara N, Suzuki N, Yamamoto M, et al. Interleukin-6 and tumor necrosis factor-α in patients with obstructive sleep apnea-hypopnea syndrome. Respiration. 2004 Jan/Feb;71(1):24-9.
  • 11 World Health Organization (WHO). Information note on COVID-19 and NCDs [Internet]. Geneva: WHO; 2020; [access in 2020 Mar 23]. Available from: https://www.who.int/internal-publications-detail/covid-19-and-ncds
  • 12 Costa D, Barbalho MC, Miguel GPS, Forti EMP, Azevedo JLMC. The impact of obesity on pulmonary function in adult women. Clinics. 2008 Dec;63(6):719-24.
  • 13 Carrascal L, Nunez-Abades P, Ayala A, Cano M. Role of melatonin in the inflammatory process and its therapeutic potential. Curr Pharm Des [Internet]. 2018; 24(14):1563-88. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29701146
  • 14 Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the perspectives of clinical immunologists from China. Clin Immunol [Internet]. 2020 May; 214:108393. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1521661620301984
  • 15 Channappanavar R, Fehr AR, Vijay R, Mack M, Zhao J, Meyerholz DK, et al. Dysregulated type I interferon and inflammatory monocyte-macrophage responses cause lethal pneumonia in SARS-CoV-infected mice. Cell Host Microbe [Internet]. 2016 Feb; 19(2):181-93. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1931312816300063
  • 16 McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med [Internet]. 2020 May; 16(9):1645. Available from: http://jcsm.aasm.org/doi/10.5664/jcsm.8538
  • 17 Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region - case series. N Engl J Med [Internet]. 2020 May; 382(21):2012-22. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2004500
  • 18 Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA [Internet]. 2020 Apr; 323(16):1612-14. Available from: https://jamanetwork.com/journals/jama/fullarticle/2763485
  • 19 Nunes JOF, Apostolico JS, Andrade DAG, Ruiz FS, Fernandes ER, Andersen ML, et al. Sleep deprivation predisposes allergic mice to neutrophilic lung inflammation. J Allergy Clin Immunol [Internet]. 2018 Mar; 141(3):1018-1027.e4. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0091674917311053
  • 20 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med [Internet]. 2017 Mar; 13(03):479-504. Available from: http://jcsm.aasm.org/doi/10.5664/jcsm.6506
  • 21 Salles C. Correspondence COVID-19: melatonin as a potential adjuvant treatment. Life Sci [Internet]. 2020 Jul; 253:117716. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0024320520304641
  • 22 Salles C, Barbosa H. COVID-19 and obstructive sleep apnea. J Clin Sleep Med. 2020 Sep;16(9):1647.
  • 23 Tufik S, Gozal D, Ishikura IA, Pires GN, Andersen ML. Does obstructive sleep apnea lead to increased risk of COVID-19 infection and severity?. J Clin Sleep Med. 2020 Aug;16(8):1425-6.
  • 24 Barlow A, Landolf KM, Barlow B, Yeung SYA, Heavner JJ, Claassen CW, et al. Review of emerging pharmacotherapy for the treatment of coronavirus disease 2019. Pharmacother J Hum Pharmacol Drug Ther [Internet]. 2020 May; 40(5):416-37. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/phar.2398
  • 25 Grote L, McNicholas WT, Hedner J. Sleep apnoea management in Europe during the COVID-19 pandemic: data from the European Sleep Apnoea Database (ESADA). Eur Respir J [Internet]. 2020 Jun; 55(6):2001323. Available from: http://erj.ersjournals.com/lookup/doi/10.1183/13993003.01323-2020