Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative

doi:10.1093/sleep/zsad126

. 2023 Sep 8;46(9):zsad126.

doi: 10.1093/sleep/zsad126.

Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative

Hannah L Mandel¹, Gunnar Colleen¹, Sajjad Abedian², Nariman Ammar³, L Charles Bailey⁴, Tellen D Bennett⁵, M Daniel Brannock⁶, Shari B Brosnahan⁷, Yu Chen¹, Christopher G Chute⁸, Jasmin Divers⁹, Michael D Evans¹⁰, Melissa Haendel¹¹, Margaret A Hall¹², Kathryn Hirabayashi⁴, Mady Hornig¹³, Stuart D Katz¹⁴, Ana C Krieger¹⁵, Johanna Loomba¹⁶, Vitaly Lorman⁴, Diego R Mazzotti¹⁷, Julie McMurry¹¹, Richard A Moffitt¹², Nathan M Pajor¹⁸, Emily Pfaff¹⁹, Jeff Radwell¹, Hanieh Razzaghi⁴, Susan Redline²⁰, Elle Seibert²¹, Anisha Sekar, Suchetha Sharma¹⁶, Tanayott Thaweethai^{22

23}, Mark G Weiner²⁴, Yun Jae Yoo¹², Andrea Zhou¹⁶, Lorna E Thorpe¹

Affiliations

¹ Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
² Information Technologies and Services Department, Weill Cornell Medicine, New York, NY, USA.
³ Department of Pediatrics, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, TN, USA.
⁴ Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁵ Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
⁶ Center for Data Science and AI, RTI International, Durham, NC, USA.
⁷ Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, NYU Langone Health, New York, NY, USA¸.
⁸ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁹ Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA.
¹⁰ Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
¹¹ Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹² Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA.
¹³ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
¹⁴ Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA.
¹⁵ Departments of Medicine, Neurology, and Genetic Medicine, Weill Cornell Medical College, New York, NY, USA.
¹⁶ Integrated Translational Health Research Institute, University of Virginia, Charlottesville, VA, USA.
¹⁷ Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
¹⁸ Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁹ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
²⁰ Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²¹ Rose International, Los Angeles, CA, USA.
²² Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
²³ Department of Medicine, Harvard Medical School, Boston, MA, USA.
²⁴ Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

PMID: 37166330
PMCID: PMC10485569
DOI: 10.1093/sleep/zsad126

Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative

Hannah L Mandel et al. Sleep. 2023.

. 2023 Sep 8;46(9):zsad126.

doi: 10.1093/sleep/zsad126.

Authors

Affiliations

¹ Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
² Information Technologies and Services Department, Weill Cornell Medicine, New York, NY, USA.
³ Department of Pediatrics, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, TN, USA.
⁴ Applied Clinical Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁵ Department of Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
⁶ Center for Data Science and AI, RTI International, Durham, NC, USA.
⁷ Division of Pulmonary, Department of Medicine, Critical Care and Sleep Medicine, NYU Langone Health, New York, NY, USA¸.
⁸ Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁹ Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA.
¹⁰ Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
¹¹ Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
¹² Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA.
¹³ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
¹⁴ Leon H. Charney Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA.
¹⁵ Departments of Medicine, Neurology, and Genetic Medicine, Weill Cornell Medical College, New York, NY, USA.
¹⁶ Integrated Translational Health Research Institute, University of Virginia, Charlottesville, VA, USA.
¹⁷ Division of Pulmonary Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
¹⁸ Division of Pulmonary Medicine Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
¹⁹ Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
²⁰ Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
²¹ Rose International, Los Angeles, CA, USA.
²² Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.
²³ Department of Medicine, Harvard Medical School, Boston, MA, USA.
²⁴ Department of Medicine, Weill Cornell Medical College, New York, NY, USA.

PMID: 37166330
PMCID: PMC10485569
DOI: 10.1093/sleep/zsad126

Abstract

Study objectives: Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC).

Methods: We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities.

Results: Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis.

Conclusions: Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.

Keywords: Chronic COVID-19 Syndrome; Late sequelae of COVID-19; Long COVID; Long haul COVID-19; Long-term COVID-19; Obstructive; Post COVID-19 syndrome; Post-acute COVID-19; Post-acute sequelae COVID-19; Post-acute sequelae of SARS-CoV-2 infection; Sleep Apnea.

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Obstructive sleep apnea association with post-acute sequelae of Severe acute respiratory syndrome coronavirus 2: insights from the NIH researching coronavirus disease 2019 to enhance recovery initiative and a call for action.
Pena-Orbea C, Mehra R. Pena-Orbea C, et al. Sleep. 2023 Sep 8;46(9):zsad147. doi: 10.1093/sleep/zsad147. Sleep. 2023. PMID: 37210669 No abstract available.

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References

1. Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B.. Global prevalence of post COVID-19 condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022;226:jiac136. doi: 10.1093/infdis/jiac136 - DOI - PMC - PubMed
1. Groff D, Sun A, Ssentongo AE, et al. . Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open. 2021;4(10):e2128568e2128568. doi: 10.1001/jamanetworkopen.2021.28568 - DOI - PMC - PubMed
1. Xie Y, Bowe B, Al-Aly Z.. Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status. Nat Commun. 2021;12(1):6571. doi: 10.1038/s41467-021-26513-3 - DOI - PMC - PubMed
1. Labarca G, Henríquez-Beltrán M, Lamperti L, et al. . Impact of obstructive sleep apnea (OSA) in COVID-19 survivors, symptoms changes between 4-months and 1 year after the COVID-19 infection. Front Med (Lausanne). 2022;9:884218. doi: 10.3389/fmed.2022.884218 - DOI - PMC - PubMed
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[1] Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B.. Global prevalence of post COVID-19 condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022;226:jiac136. doi: 10.1093/infdis/jiac136 - DOI - PMC - PubMed

[2] Chen C, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B.. Global prevalence of post COVID-19 condition or long COVID: a meta-analysis and systematic review. J Infect Dis. 2022;226:jiac136. doi: 10.1093/infdis/jiac136 - DOI - PMC - PubMed

[3] Groff D, Sun A, Ssentongo AE, et al. . Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open. 2021;4(10):e2128568e2128568. doi: 10.1001/jamanetworkopen.2021.28568 - DOI - PMC - PubMed

[4] Groff D, Sun A, Ssentongo AE, et al. . Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open. 2021;4(10):e2128568e2128568. doi: 10.1001/jamanetworkopen.2021.28568 - DOI - PMC - PubMed

[5] Xie Y, Bowe B, Al-Aly Z.. Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status. Nat Commun. 2021;12(1):6571. doi: 10.1038/s41467-021-26513-3 - DOI - PMC - PubMed

[6] Xie Y, Bowe B, Al-Aly Z.. Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status. Nat Commun. 2021;12(1):6571. doi: 10.1038/s41467-021-26513-3 - DOI - PMC - PubMed

[7] Labarca G, Henríquez-Beltrán M, Lamperti L, et al. . Impact of obstructive sleep apnea (OSA) in COVID-19 survivors, symptoms changes between 4-months and 1 year after the COVID-19 infection. Front Med (Lausanne). 2022;9:884218. doi: 10.3389/fmed.2022.884218 - DOI - PMC - PubMed

[8] Labarca G, Henríquez-Beltrán M, Lamperti L, et al. . Impact of obstructive sleep apnea (OSA) in COVID-19 survivors, symptoms changes between 4-months and 1 year after the COVID-19 infection. Front Med (Lausanne). 2022;9:884218. doi: 10.3389/fmed.2022.884218 - DOI - PMC - PubMed

[9] Franklin KA, Lindberg E.. Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311–1322. doi:10.3978/j.issn.2072-1439.2015.06.11 - DOI - PMC - PubMed

[10] Franklin KA, Lindberg E.. Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311–1322. doi:10.3978/j.issn.2072-1439.2015.06.11 - DOI - PMC - PubMed

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Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative

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Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative

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