# Obstructive Sleep Apnea as a Risk Factor for Pneumonia Among Patients Infected SARS-CoV-2: A Propensity Score-Matching Analysis

## TL;DR

This study finds that obstructive sleep apnea increases the risk of pneumonia in patients infected with SARS-CoV-2, even after adjusting for other factors.

## Contribution

The study demonstrates that OSA is an independent risk factor for COVID-19 pneumonia using propensity score matching.

## Key findings

- OSA was present in 36.76% of SARS-CoV-2-infected patients.
- OSA was independently associated with a 4.56-fold increased risk of pneumonia.
- Patients with OSA showed more severe nocturnal hypoxemia and radiological signs of pneumonia.

## Abstract

Background

Obstructive sleep apnea (OSA) and coronavirus disease 2019 (COVID-19) share key pathophysiological features, including intermittent hypoxemia, systemic inflammation, and endothelial dysfunction, which may worsen clinical outcomes. However, whether OSA independently increases the risk of COVID-19 pneumonia remains unclear. This study aimed to assess the association between OSA and the risk of COVID-19 pneumonia in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methodology

In this single-center, cross-sectional study, 136 hospitalized patients with confirmed SARS-CoV-2 infection were evaluated. OSA was diagnosed using home sleep apnea testing (HSAT), defined by an apnea-hypopnea index (AHI)≥five events/hour. Propensity score matching (PSM) was performed at a 1:1 ratio based on age, sex, body mass index (BMI), smoking history, and hypertension. Multivariate logistic regression was used to identify independent risk factors for COVID-19 pneumonia.

Results

The overall prevalence of OSA among patients infected with SARS-CoV-2 was 36.76% (50/136). After PSM, 32 patients with OSA were matched to 32 controls without OSA. The prevalence of pneumonia-related abnormalities on chest computed tomography (CT), including patchy or ground-glass opacities, was significantly higher in the OSA group compared to the non-OSA group. Furthermore, patients with OSA exhibited more severe nocturnal hypoxemia, as reflected by elevated oxygen desaturation index (ODI) and increased total sleep time with oxygen saturation below 90% (TST90). Multivariate logistic regression analysis identified age ≥60 years (odds ratio (OR)=12.05, p=0.004) and the presence of OSA (OR=4.56, p=0.010) as independent risk factors of COVID-19 pneumonia.

Conclusions

OSA was common among patients infected with SARS-CoV-2 and was independently associated with an increased risk of developing COVID-19 pneumonia, even after adjustment for major confounders. Patients with OSA exhibited more frequent radiological evidence of pneumonia and worse sleep-related respiratory parameters.