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Abstract
Rationale/objectives Despite plausible pathophysiological mechanisms, more research is needed to confirm the relationship between obstructive sleep apnoea (OSA) and the risk of COVID-19 infection or COVID-19-related serious complications.
Methods We conducted a retrospective population-based cohort study using provincial health administrative data (Ontario, Canada). Adults with physician-diagnosed OSA who received positive airway pressure therapy in the 5 years prepandemic (OSA group) were propensity score matched by baseline characteristics to individuals in the general population at low risk of OSA (non-OSA group) using inverse probability of treatment weighting. Weighted HRs of (1) a positive COVID-19 test and (2) COVID-19-related emergency department (ED) visits, hospitalisations, intensive care unit (ICU) admissions and mortality, within 12 months of pandemic onset, were compared between groups. We also evaluated the impact of comorbid cardiometabolic or chronic airways disease.
Results We identified and matched 324 029 individuals in the OSA group to 4 588 200 individuals in the non-OSA group. Compared with the non-OSA group, those in the OSA group were at a greater hazard of testing positive for COVID-19 (HR=1.17, 95% CI 1.13 to 1.21), having a COVID-19-related ED visit (HR=1.62, 95% CI 1.51 to 1.73), hospitalisation (HR=1.50, 95% CI 1.37 to 1.65) or ICU admission (HR=1.53, 95% CI 1.27 to 1.84). COVID-19-related 30-day mortality was not different (HR=0.98, 95% CI 0.82 to 1.16).
We found that for the OSA group, comorbid airways disease but not cardiometabolic conditions increased the hazards of COVID-19-related outcomes, including mortality.
Conclusion In this large population-based study, we demonstrated that a recent diagnosis of OSA requiring treatment was associated with an increased hazard of testing positive for COVID-19 and serious COVID-19-related complications, particularly in those with co-existing chronic airways disease.
- sleep apnoea
- COVID-19
- clinical epidemiology
Data availability statement
Data may be obtained from a third party and are not publicly available. In Ontario, the dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.
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Data availability statement
Data may be obtained from a third party and are not publicly available. In Ontario, the dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: das@ices.on.ca). The full dataset creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.
Footnotes
Twitter @srpendharkar
Contributors All coauthors were involved in the following: study conception and design, interpretation of the data, critical revision of the manuscript for accuracy and important intellectual content, and final approval of the version to be published. TK was additionally involved in obtaining administrative data, analyses of data and drafting the manuscript. RT was additionally involved in data analyses, visual data presentation and drafting the Methods section. SRP was additionally involved in drafting of the manuscript.
Guarantor Statement: Together, TK and RT had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. They affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained. All authors had full access to statistical reports and tables.
Funding This study was supported by the Lung Health Foundation Breathing as One Young Investigators Research Award, the Ontario Health Data Platform (OHDP), a province of Ontario initiative to support Ontario's ongoing response to COVID-19 and its related impacts, and by ICES (formerly known as the Institute for Clinical Evaluative Sciences), which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This document used data adapted from the Statistics Canada Postal CodeOM Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the Ontario Ministry of Health Postal Code Conversion File, which contains data copied under license from Canada Post Corporation and Statistics Canada. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI). The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Specifically, no endorsement by the OHDP, its partners, or the Province of Ontario, and ICES, CIHI or the Ontario MOH and/or MLTC is intended or should be inferred.
Competing interests TK is supported by the Physicians' Services Incorporated (PSI) foundation: The 2020 PSI Graham Farquharson Knowledge Translation Fellowship. She also received a speaker honorarium from AstraZeneca Canada Inc. and is a Clinical Consultant at Pitolisant Medical Advisory Board (Paladin Labs Inc.). RR received consultation fees from Eisai for a report unrelated to this study. SRP is supported by an unrestricted sponsorship grant from Jazz Pharmaceuticals and received consulting fees from Jazz Pharmaceuticals, Paladin Labs and the International Centre for Professional Development in Health and Medicine. MP received consulting fees from Paladin Labs and Jazz Pharmaceuticals as well as contract research funds from Jazz Pharmaceuticals.
Provenance and peer review Not commissioned; externally peer reviewed.
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