Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
ICES, Ottawa, Ontario, Canada.
Thorax. 2023 Sep;78(9):933-941. doi: 10.1136/thorax-2022-219574. Epub 2023 Jan 30.
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.
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 () were propensity score matched by baseline characteristics to individuals in the general population at low risk of OSA () 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.
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.
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.
背景/目的：尽管有合理的病理生理学机制，但仍需要更多研究来证实阻塞性睡眠呼吸暂停（OSA）与 COVID-19 感染风险或 COVID-19 相关严重并发症之间的关系。
我们使用省级卫生行政数据（加拿大安大略省）进行了一项回顾性基于人群的队列研究。在大流行前 5 年（）接受过正压通气治疗的经医生诊断患有 OSA 的成年人，根据基线特征，使用逆概率治疗加权法（inverse probability of treatment weighting）与 OSA 风险较低的一般人群（）中的个体进行倾向评分匹配。在大流行开始后的 12 个月内，比较两组之间（1）COVID-19 检测阳性和（2）COVID-19 相关急诊就诊、住院、重症监护病房（ICU）入院和死亡的加权 HR。我们还评估了合并心血管代谢或慢性气道疾病的影响。
我们在 OSA 组中识别并匹配了 324029 人，在非 OSA 组中匹配了 4588200 人。与非 OSA 组相比，OSA 组 COVID-19 检测阳性的风险更高（HR=1.17，95%CI 1.13 至 1.21），COVID-19 相关急诊就诊（HR=1.62，95%CI 1.51 至 1.73）、住院（HR=1.50，95%CI 1.37 至 1.65）或 ICU 入院（HR=1.53，95%CI 1.27 至 1.84）的风险也更高。COVID-19 相关 30 天死亡率没有差异（HR=0.98，95%CI 0.82 至 1.16）。我们发现，对于 OSA 组，合并气道疾病而不是心血管代谢疾病会增加 COVID-19 相关结局（包括死亡率）的风险。
在这项大型基于人群的研究中，我们表明，最近诊断为需要治疗的 OSA 与 COVID-19 检测阳性和严重 COVID-19 相关并发症的风险增加有关，特别是在合并慢性气道疾病的患者中。
