714 Sleep Disordered Breathing Polysomnographic Measures and COVID-19 Risk of WHO-7 Clinical Outcomes in a Large Health Care System

• Published in: Sleep (New York, N.Y.) N.Y.), 2021-05, Vol.44 (Supplement_2), p.A278-A279
• Main Authors: Pena Orbea, Cinthya, Wang, Lu, Shah, Vaishal, Jehi, Lara, Milinovich, Alex, Foldvary-Schaefer, Nancy, Chung, Mina, Mashaqi, Saif, Mehra, Reena
• Format: Article
• Language: English
• Subjects: B. Clinical Sleep Science and Practice; Body mass index; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical outcomes; Coronaviruses; COVID-19; Hypoxemia; Hypoxia; Severe acute respiratory syndrome coronavirus 2; Sleep; Sleep disorders
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsab072.712

Introduction There is lack of clarity of sleep disordered breathing (SDB)--including the role of nocturnal hypoxia and confounding influence of obesity--on the clinical course of human coronavirus disease 2019 (COVID-19). We postulate that SDB portends increased risk of adverse COVID-19 clinical outcomes even after accounting for confounding factors. Methods A retrospective cohort analysis of COVID-19 and sleep laboratory observational registries March-November 2020 within the Cleveland Clinic health system was performed. Ordinal logistic regression assessed the association of SDB indices and World Health Organization (WHO)-7 COVID-19 clinical outcome (hospitalization, use of supplemental oxygen, non-invasive ventilation, mechanical ventilation/ECMO and death) in an unadjusted model and adjusted for age, sex, race, body mass index(BMI,kg/m2),diabetes mellitus, hypertension, coronary artery disease, heart failure, asthma, chronic obstructive pulmonary disease (COPD), cancer and smoking using SAS software. Results Of 19,449 (32%) patients positive for SARS-CoV-2,2,290 (6%) had an available sleep study. The analytic sample included 1788 of which 1,484(64%) had an apnea hypopnea index (AHI, 3–4% hypopnea oxygen desaturation)≥5. The median duration from sleep study to COVID test was 5.8 years (IQR:3.3–9.0). Age was 56.5±14.4 years,50.4% female,28% African American with BMI=35.9±8.9kg/m2. Nine percent of patients were hospitalized,10% with supplemental oxygen,6% used non-invasive ventilation,2% required ECMO or mechanical ventilation and 2% died. For every AHI increase of 5, the odds of a higher WHO-7 level increased 2% (OR=1.02,95%CI1.01-1.04,p=0.005),but the association was mitigated in the adjusted model (OR=1.00,95%CI:0.98,1.02,p=0.80). Per 5% increase in time spent with SaO2