Labarca Gonzalo, Henríquez-Beltrán Mario, Lamperti Liliana, Nova-Lamperti Estefania, Sanhueza Sergio, Cabrera Camilo, Quiroga Romina, Antilef Barbara, Ormazábal Valeska, Zúñiga Felipe, Castillo Daniela, Horta Gloria, Enos Daniel, Lastra Jaime, Gonzalez Jessica, Targa Adriano, Barbe Ferran
Molecular and Translational Immunology Laboratory, Clinical Biochemistry and Immunology Department, Faculty of Pharmacy, Universidad de Concepción, Concepción, Chile.
Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
Front Med (Lausanne). 2022 Jun 14;9:884218. doi: 10.3389/fmed.2022.884218. eCollection 2022.
To determine the association between Obstructive Sleep Apnea (OSA) with long-term symptoms and inflammatory cytokines, exploring the changes between 4-months and 1-year after COVID-19 infection.
We conducted an observational, prospective cohort study, including patients ≥18 years old with confirmed diagnosis of COVID-19 between April to July 2020. All participants underwent two clinical follow-up visits, the first at 4-months (Visit 1) and the second at 1 year, after SARS-CoV-2 infection (Visit 2). Plasma glucose, total cholesterol, HDL, and triglycerides. Regarding pulmonary function, spirometry and lung diffusion capacity tests were assessed. For mental and neurocognitive evaluation, a short-form (SF-12), Beck depression and Hospital-Anxiety depression questionnaires were conducted at both time-points, whereas the Montreal Cognitive assessment was conducted during the second follow-up. Regarding to sleep evaluation, Epworth Sleepiness Scale, Insomnia Severity index and STOP-BANG questionnaire were conducted. Additionally, a home sleep apnea test and 7-day wrist actigraphy were performed in all participants. Inflammatory cytokines were measured using an inflammatory cytokine bead array kit. values < 0.05 were considered statistically significant and statistical analyses were performed using R software.
A total of 60 patients were included in the first follow-up, from which 57 completed the second follow-up. The mean age was 46.4 years-old (SD ± 13.1) and 53.3% were male. 30% of cases reported mild COVID-19 infection, 28.3% with moderate illness, and 41.6% with severe illness. Moreover, 56.6% of them were admitted to the ICU. Regarding to metabolic values, the OSA group showed higher values of insulin resistance (IR) (27%), systolic blood pressure (SBP) 135.2 (±19.1), dyslipidemia (67.5%), total cholesterol 202.1 (±60.5), triglycerides 176.1 (±119.0) and HOMA-IR 9.0 (±18.8) in comparison with the non-OSA group. 1 year after COVID-19 infection, DLCO test remains abnormal in OSA patients (25% OSA vs. 3.6% non-OSA, = 0.02). Finally, those participants with OSA who develop ARDS reported an adjusted OR 20.4 (95%-CI, 1.04-504) risk of neurocognitive impairment.
Among patients with previous COVID-19, OSA impact the development of incident glycemic, neurocognitive impairment, and abnormal functional pulmonary changes that persist up to 1 year since acute phase.
确定阻塞性睡眠呼吸暂停（OSA）与长期症状和炎性细胞因子之间的关联，探索新冠病毒感染后4个月至1年之间的变化。
我们进行了一项观察性前瞻性队列研究，纳入2020年4月至7月确诊感染新冠病毒的18岁及以上患者。所有参与者均接受两次临床随访，第一次在感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后4个月（第一次随访），第二次在1年后（第二次随访）。检测血浆葡萄糖、总胆固醇、高密度脂蛋白和甘油三酯。关于肺功能，评估了肺活量测定和肺弥散能力测试。在两个时间点均进行了精神和神经认知评估，采用简短健康调查量表（SF-12）、贝克抑郁问卷和医院焦虑抑郁问卷，而蒙特利尔认知评估在第二次随访时进行。关于睡眠评估，进行了爱泼华嗜睡量表、失眠严重程度指数和STOP-BANG问卷调查。此外，所有参与者均进行了家庭睡眠呼吸暂停测试和7天腕部活动记录仪监测。使用炎性细胞因子微珠阵列试剂盒测量炎性细胞因子。P值<0.05被认为具有统计学意义，使用R软件进行统计分析。
第一次随访共纳入60例患者，其中57例完成了第二次随访。平均年龄为46.4岁（标准差±13.1），男性占53.3%。30%的病例报告为轻度新冠病毒感染，28.3%为中度疾病，41.6%为重度疾病。此外，56.6%的患者被收入重症监护病房。关于代谢指标，与非OSA组相比，OSA组的胰岛素抵抗（IR）值更高（27%），收缩压（SBP）为135.2（±19.1），血脂异常（67.5%），总胆固醇202.1（±60.5），甘油三酯176.1（±119.0），稳态模型评估胰岛素抵抗（HOMA-IR）为9.0（±18.8）。新冠病毒感染1年后，OSA患者的一氧化碳弥散量（DLCO）测试仍异常（OSA组为25%，非OSA组为3.6%，P = 0.02）。最后，发生急性呼吸窘迫综合征（ARDS）的OSA参与者发生神经认知障碍的校正比值比为20.4（95%置信区间，1.04 - 504）。
在既往感染新冠病毒的患者中，OSA影响血糖、神经认知障碍的发生发展，以及自急性期起持续长达1年的肺部功能异常变化。
