Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Throughout the COVID-19 pandemic, infected patients with a variety of comorbidities have experienced far worse outcomes. These include cancer survivors along with patients who have diabetes, heart conditions, and chronic kidney or liver disease. A pair of recent JAMA Psychiatry meta-analyses also connected mental illness with a higher rate of death or hospitalization from COVID-19. Earlier studies have also indicated that an infected patient’s weight had an outsized effect on outcomes with BMIs over 25 associated with a greater risk that those patients will be hospitalized, admitted into the ICU, or die. This was unsurprising given that in general overweight patients are at greater risk for poor outcomes from a variety of other respiratory illnesses.

Recently another condition has been added to the list –– and it’s one of particular interest for neurologists who treat patients with sleep-disordered breathing. That’s because a study conducted at the Cleveland Clinic suggests some sleep disorders may be linked to more severe outcomes from COVID-19.

Disordered Breathing and COVID-19 

Our breathing changes as we sleep. During non-REM sleep, our breathing decreases by 15%. During REM sleep, however, our breathing is much heavier and even erratic to the point that we can even stop breathing for brief periods of time. Unfortunately, for some people those brief pauses last longer than a few seconds. When this occurs, oxygen levels in the blood become dangerously low –– sometimes dropping below 90%. Interestingly, while this level is a marker for sleep-related hypoxia, people with COVID-19 who utilize a home pulse oximeter are encouraged to seek medical attention if their levels dip below 95%.

To examine the hospitalization and fatality risk for people with sleep-related hypoxia, researchers relied upon the Cleveland Clinic’s COVID-19 research registry. From that list of nearly 360,000 patients who’d tested positive for COVID-19, they excluded all but the 5,400 who also had a record from a sleep study. After accounting for comorbidities, the study concluded that while having sleep-related hypoxia did not increase a patient’s risk for contracting the SARS-CoV-2 virus, it did increase their risk of hospitalization and mortality by nearly one-third when compared to others who tested positive for the virus. 

Since sleep-disordered breathing and sleep-related hypoxia are often connected to neurological conditions, neurologists may want to consider earlier administration of PAP (positive airway pressure) or oxygen administration if their patients test positive for COVID-19.

References

• People with Certain Medical Conditions
• Association Between Mental Health Disorders and Mortality Among Patients With COVID-19 in 7 Countries A Systematic Review and Meta-analysis
• Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study
• Why COVID-19 is more deadly in people with obesity—even if they’re young
• Sleep-disordered breathing in neurologic conditions
• Association of Sleep-Related Hypoxia With Risk of COVID-19 Hospitalizations and Mortality in a Large Integrated Health System