Previously diagnosed obstructive sleep apnea is not associated with increased risk of SARS-CoV-2 infection in community-dwelling older adults living in a highly endemic setting

Oscar H Del Brutto; Robertino M Mera; Pablo R Castillo; Bettsy Y Recalde; Aldo F Costa

doi:10.1016/j.clineuro.2021.106639

Previously diagnosed obstructive sleep apnea is not associated with increased risk of SARS-CoV-2 infection in community-dwelling older adults living in a highly endemic setting

Clin Neurol Neurosurg. 2021 Jun:205:106639. doi: 10.1016/j.clineuro.2021.106639. Epub 2021 Apr 12.

Authors

Oscar H Del Brutto¹, Robertino M Mera², Pablo R Castillo³, Bettsy Y Recalde⁴, Aldo F Costa⁴

Affiliations

¹ School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
² Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA.
³ Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, Florida, USA.
⁴ Community Center, the Atahualpa Project, Atahualpa, Ecuador.

Abstract

Objective: In view of the high prevalence of obstructive sleep apnea (OSA) and the increasing global pandemic of SARS-CoV-2 infection, it is likely that many patients with OSA get exposed to this virus. Besides theoretical assumptions, there is no evidence that OSA may favor SARS-CoV-2 acquisition or may lead to a more severe disease. Taking the opportunity of the Atahualpa Project cohort, we aimed to assess the relationship between previously diagnosed OSA and SARS-CoV-2 infection in older adults living in rural Ecuador.

Patients and methods: SARS-CoV-2 antibodies were determined in 180 individuals aged > 60 years that underwent polysomnography previously to this novel pandemic. Those with OSA remained untreated due to income limitations. Exposure-effect models were fitted with OSA as the exposure, SARS-CoV-2 seropositivity and symptomatology as the outcomes, and confounders - age, gender, obesity, arterial hypertension, diabetes mellitus, hypercholesterolemia, individuals per house, home confinement - as independent variables.

Results: A total of 87 (48%) individuals were seropositive to SARS-CoV-2, 77% of whom were symptomatic. The mean apnea/hypopnea index was 11.1 ± 11.7 episodes per hour, with 83 (46%) individuals having mild, and 38 (21%) moderate-to-severe OSA. Exposure-effect models demonstrated lack of relationship between OSA and SARS-CoV-2 seropositivity and symptomatology.

Conclusions: This study shows no relationship between history of OSA and SARS-CoV-2 seropositivity or symptomatology, opposing previous suggestions that persons with OSA are more prone to acquire the infection and have a more severe disease.

Keywords: Apnea hipopnea index; Coronavirus-19; Obstructive sleep apnea; Population study; SARS-CoV-2.