Obstructive Sleep Apnea and COVID-19 Infection Comorbidity: Analysis of the Problem in the Age Aspect

Olga Berdina, Irina Madaeva, Lyubov Rychkova

International Journal of Biomedicine. 2020;10(4):312-315.
DOI: 10.21103/Article10(4)_RA1
Originally published December 10, 2020


In the literature, there are suggestions of a possible mutual influence between obstructive sleep apnea (OSA) and the novel coronavirus disease 2019 (COVID-19).The aim of this review is to analyze data found in the literature related to pathogenetic aspects of the impact of OSA on COVID-19, and vice versa, and features of the course of this comorbidity in both adulthood and childhood. Information was searched in MEDLINE, PubMed, EBSCO, and RSCI databases, which presented some data for the connection between COVID-19 and OSA, as well as aspects of OSA and COVID-19 comorbidity for adults and the elderly. The common pathophysiological pathways leading to increased systemic inflammation and adverse consequences of OSA and COVID-19 infection do coexist and were revealed in detail. We paid special attention to aspects of this comorbidity in children, and found that research in this area was lacking. Based on this information, it should be concluded that: 1) more pediatric studies of links between OSA and COVID-19 are urgently needed; 2) screening hospitalized COVID-19 patients with tools to detect OSA could identify those at risk for a severe course of these diseases and adverse outcomes; 3) treating OSA will allow increasing the likelihood of developing a robust and long-lasting post-COVID-19 adaptive immunity in these patients.

obstructive sleep • COVID-19 • comorbidity • pathogenesis • adults • children
  1. WHO. Coronavirus Disease (COVID-19). Situation Report – 209. Available at https://www.who.int/docs/default-source/coronaviruse/situation-reports/2.... Data as received by WHO from national authorities by 10:00 CEST, 16 August 2020
  2. WHO. Coronavirus disease (COVID-19). Available at https://www.who.int/docs/default-source/coronaviruse/situation-reports/2.... Data as received by WHO from national authorities, as of 10 am CEST 20 September 2020
  3. WHO/Europe. COVID-19 situation in the WHO European Region. Copenhagen, Denmark. World Health Organization. Regional Office for Europe; 2020. Available at https://who.maps.arcgis.com/apps/opsdashboard/index.html#/ead3c647565448...
  4. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 10;41(2):145-151. Chinese. doi: 10.3760/cma.j.issn.0254-6450.2020.02.003. PMID: 32064853. [Article in Chinese]
  5. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA. 2020 Apr 14;323(14):1335. doi: 10.1001/jama.2020.4344.
  6. CDC COVID-19 Response Team. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020 Mar 27;69(12):343-346. doi: 10.15585/mmwr.mm6912e2. 
  7. WHO. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Scientific Brief. 15 May 2020. Available at https://www.who.int/news-room/commentaries/detail/multisystem-inflammato...
  8. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020 May 23;395(10237):1607-1608. doi: 10.1016/S0140-6736(20)31094-1.
  9. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020 Apr;8(4):420-422. doi: 10.1016/S2213-2600(20)30076-X. Epub 2020 Feb 18. Erratum in: Lancet Respir Med. 2020 Feb 25;: 
  10. CDC. Centers for Disease Control and Prevention. Provisional COVID-19 Deaths: Focus on Ages 0-18 Years. Deaths involving coronavirus disease 2019 (COVID-19) with a focus on ages 0-18 years in the United States. Available at https://data.cdc.gov/NCHS/Provisional-COVID-19-Deaths-Focus-on-Ages-0-18-Yea/nr4s-juj3
  11. Yang Y, Lu Q, Liu M, Wang Y, Zhang A, Jalali N, et al. Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China. medRxiv 2020.02.10.20021675; doi: 10.1101/2020.02.10.20021675
  12. Lu X, Zhang L, Du H, Zhang J, Li Y, Quet J, et al.; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in Children. N Engl J Med. 2020 Apr 23;382(17):1663-1665. doi: 10.1056/NEJMc2005073.
  13. Shinkin MV, Zvenigorodskaya LA, Mkrtumyan AM. [COVID-19 and diabetes mellitus: what we know about it]. Effective pharmacotherapy. 2020;16(17):26-33. doi: 10.33978/2307-3586-2020-16-17-26-33. [Article in Russian].
  14. Kravchuk EN, Neimark AE, Babenko AYu, Grineva EN. [Obesity and COVID-19]. Arterial hypertension. 2020;26 (4):439–445. doi: 10.18705 / 1607-419X-2020-26-4-440-446.  [Article in Russian].
  15. Buzunov RV. [Obesity and sleeping breathing disorders as risk factors of severe COVID-19]. Date accessed: September 15 2020. Available at https://buzunov.ru/osas_covid/. [Article in Russian].
  16. Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis. 2016 Feb;8(2):224-35. doi: 10.3978/j.issn.2072-1439.2015.12.04.
  17. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013 May 1;177(9):1006-14. doi: 10.1093/aje/kws342. 
  18. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet. 2014 Feb 22;383(9918):736-47. doi: 10.1016/S0140-6736(13)60734-5. 
  19. Ciment AJ, Ciment LM. A 55-year-old COVID-19-positive man managed with self-regulation of high-flow oxygen by high-velocity nasal insufflation therapy. Respirol Case Rep. 2020 May 21;8(5):e00591. doi: 10.1002/rcr2.591.
  20. Memtsoudis SG, Ivascu NS, Pryor KO, Goldstein PA. Obesity as a risk factor for poor outcome in COVID-19-induced lung injury: the potential role of undiagnosed obstructive sleep apnoea. Br J Anaesth. 2020 Aug;125(2):e262-e263. doi: 10.1016/j.bja.2020.04.078.
  21. Mittal A, Forte M, Leonard R, Sangani R, Sharma S. Refractory Acute Respiratory Distress Syndrome Secondary to COVID-19 Successfully Extubated to Average Volume-assured Pressure Support Non-invasive Ventilator. Cureus. 2020 Apr 27;12(4):e7849. doi: 10.7759/cureus.7849.
  22. Kragholm K, Andersen MP, Gerds TA, Butt JH, Østergaard L, Polcwiartek C, Phelps M, Andersson C, Gislason GH, Torp-Pedersen C, Køber L, Schou M, Fosbøl EL. Association between male sex and outcomes of Coronavirus Disease 2019 (Covid-19) - a Danish nationwide, register-based study. Clin Infect Dis. 2020 Jul 8:ciaa924. doi: 10.1093/cid/ciaa924. 
  23. Huang JF, Wang XB, Zheng KI, Liu WY, Chen JJ, George J, Zheng MH. Letter to the Editor: Obesity hypoventilation syndrome and severe COVID-19. Metabolism. 2020 Jul;108:154249. doi: 10.1016/j.metabol.2020.154249. 
  24. 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 15;16(8):1425-1426. doi: 10.5664/jcsm.8596.
  25.  McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med. 2020 Sep 15;16(9):1645. doi: 10.5664/jcsm.8538. 
  26. Woo J, Weber G, Nathan N. A COVID-19 Conundrum: Obstructive Sleep Apnea (OSA) and Noninvasive Ventilation (NIV). Anesth Analg. 2020 Aug;131(2):317. doi: 10.1213/ANE.0000000000004998. 
  27. Salles C, Mascarenhas Barbosa H. COVID-19 and obstructive sleep apnea. J Clin Sleep Med. 2020 Sep 15;16(9):1647. doi: 10.5664/jcsm.8606.
  28. Kheirandish-Gozal L, Gozal D. Obstructive Sleep Apnea and Inflammation: Proof of Concept Based on Two Illustrative Cytokines. Int J Mol Sci. 2019 Jan 22;20(3):459. doi: 10.3390/ijms20030459. 
  29. Martusevich A, Karuzin K, Zhdanova O. Immune and Metabolic Response to COVID-19 Infection: Review for Molecular Pathways. International Journal of Biomedicine. 2020;10(3):177-181. doi: 10.21103/Article10(3)_RA1.
  30. Darenskaya MA, Gavrilova OA, Rychkova LV, Kravtsova OV, Grebenkina LA, Osipova EV, et al. The assessment of oxidative stress intensity in adolescents with obesity by the integral index. International Journal of Biomedicine. 2018;8(1):37-41. doi: 10.21103/Article8(1)_OA5.
  31. Kolesnikova LI, Madaeva IM, Semenova NV, Vlasov BY, Grebenkina LA, Darenskaya MA, Dolgikh MI. Antioxidant potential of the blood in men with obstructive sleep breathing disorders. Bull Exp Biol Med. 2013 Apr;154(6):731-3. doi: 10.1007/s10517-013-2041-4. 
  32. Suen CM, Hui DSC, Memtsoudis SG, Chung F. Obstructive Sleep Apnea, Obesity, and Noninvasive Ventilation: Considerations During the COVID-19 Pandemic. Anesth Analg. 2020 Aug;131(2):318-322. doi: 10.1213/ANE.0000000000004928. 
  33. Cariou B, Hadjadj S, Wargny M, Pichelin M, Al-Salameh A, Allix I, et al.; CORONADO investigators. Phenotypic characteristics and prognosis of inpatients with COVID-19 and diabetes: the CORONADO study. Diabetologia. 2020 Aug;63(8):1500-1515. doi: 10.1007/s00125-020-05180-x. 
  34. Cade BE, Dashti HS, Hassan SM, Redline S, Karlson EW. Sleep Apnea and COVID-19 Mortality and Hospitalization. Am J Respir Crit Care Med. 2020 Sep 18. doi: 10.1164/rccm.202006-2252LE.
  35. Ekiz T, İnönü Köseoğlu H, Pazarlı AC. Obstructive sleep apnea, renin-angiotensin system, and COVID-19: possible interactions. J Clin Sleep Med. 2020 Aug 15;16(8):1403-1404. doi: 10.5664/jcsm.8576. 
  36. McSharry D, Malhotra A. Potential influences of obstructive sleep apnea and obesity on COVID-19 severity. J Clin Sleep Med. 2020 Sep 15;16(9):1645. doi: 10.5664/jcsm.8538. 
  37. Attias D, Pepin JL, Pathak A. Impact of COVID-19 lockdown on adherence to continuous positive airway pressure by obstructive sleep apnoea patients. Eur Respir J. 2020 Jul 30;56(1):2001607. doi: 10.1183/13993003.01607-2020. 
  38. Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev. 2020 Apr 3;29(155):200068. doi: 10.1183/16000617.0068-2020. 
  39. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al.; American Academy of Pediatrics. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012 Sep;130(3):e714-55. doi: 10.1542/peds.2012-1672. 
  40. Ehsan Z, Ishman SL. Pediatric Obstructive Sleep Apnea. Otolaryngol Clin North Am. 2016 Dec;49(6):1449-1464. doi: 10.1016/j.otc.2016.07.001. 
  41. Berdina O, Madaeva I, Rychkova L, Bugun O, Kolesnikova L. Obstructive sleep apnea as predictor of cardiovascular risk factors in male adolescents with essential hypertension. Sleep Med 2017; 40(Suppl. 1): e31.7.
  42. Madaeva I, Berdina O, Mandzyak T, Kolesnikov S, Kolesnikova L. Sleep patterns in adolescents with hypertension. International Journal of Biomedicine.  2016;6(1):53-55. doi: 10.21103/Article6(1)_OA11.
  43. Needleman JS, Hanson AE. COVID-19-associated apnea and circumoral cyanosis in a 3-week-old. BMC Pediatr. 2020 Aug 12;20(1):382. doi: 10.1186/s12887-020-02282-8. 
  44. González Brabin A, Iglesias-Bouzas MI, Nieto-Moro M, Martínez de Azagra-Garde A, García-Salido A. Apnea neonatal como manifestación inicial de infección por SARS-CoV-2 [Neonatal apnea as initial manifestation of SARS-CoV-2 infection]. An Pediatr (Barc). 2020 Sep;93(3):215-216. Spanish. doi: 10.1016/j.anpedi.2020.05.008.
  45. Enner S, Hormozdyaran S, Varughese R, Milillo J, Pavkovic I, Laureta E, et al. Central Apnea in an Adolescent With COVID-19. Pediatr Neurol. 2020 Sep;110:87-88. doi: 10.1016/j.pediatrneurol.2020.05.012. 
  46. Krishnan US, Krishnan SS, Jain S, Chavolla-Calderon MB, Lewis M, Chung WK, Rosenzweig EB. SARS-CoV-2 Infection in Patients with Down Syndrome, Congenital Heart Disease, and Pulmonary Hypertension: Is Down Syndrome a Risk Factor? J Pediatr. 2020 Oct;225:246-248. doi: 10.1016/j.jpeds.2020.06.076. 

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Received September 24, 2020.
Accepted October 25, 2020.
©2020 International Medical Research and Development Corporation.