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COVID-19: Patients with sleep apnea may be at additional risk

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A new study from the University of Warwick shows that people diagnosed with obstructive sleep apnea may be at increased risk of adverse outcomes from COVID-19.

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The conclusions are drawn from a systematic review of studies that reported outcomes in patients with COVID-19 diagnosed with obstructive sleep apnea. Published in the journal Hypnotic ReviewThe review emphasizes the need to further investigate the effects of the virus on people in sleep and better identify those who are not currently diagnosed.

Obstructive sleep apnea is a condition characterized by complete or partial obstruction of the airways that weakens muscles during sleep. People who snore, hold their breath, or appear to suffocate during sleep, especially those who are obese, are generally diagnosed in those who are more likely to experience it. If you make strange noises during sleep or if you feel that you have stopped breathing during sleep, talk to your GP about requesting a sleep service to check your condition.

Many of the risk factors and comorbidities associated with sleep apnea, such as diabetes, obesity, and hypertension, are similar to those associated with a poor prognosis for COVID-19. However, the researchers wanted to investigate whether the diagnosis of obstructive sleep apnea poses additional risks in addition to these factors.

A systematic review reviewed 18 studies up to June 2020 on obstructive sleep apnea and COVID-19. Eight of these were primarily associated with the risk of death from COVID-19, and 10 were associated with the diagnosis, treatment and management of sleep apnea. .. Few studies of obstructive sleep apnea with COVID-19 were conducted at the time, but many patients who received intensive care had obstructive sleep apnea, and other diabetic patients. There is evidence suggesting that it may lead to an increase in risk independent of risk factors. In one large study of diabetic patients admitted with COVID-19, patients treated for obstructive sleep apnea were 2.8 times more likely to die 7 days after admission.

Researchers believe that up to 85% of obstructive sleep apnea disorders have not been detected in the UK, and 1.5 million people in the UK currently diagnosed with this condition may be just the tip of the iceberg. It suggests that there is. With an increase in obesity and other related risk factors, the researchers also believe that the rate of obstructive sleep apnea is also increasing. The review also emphasizes that the pandemic has had a global impact on the ongoing diagnosis, management, and treatment of patients with this and other sleep states. In the future, it may be necessary to explore new diagnostic and therapeutic pathways for these individuals.

Dr. Michel Miller of Warwick Medical School, the lead author of the study, said:

“This condition is not well diagnosed and it is unclear whether undiagnosed sleep apnea poses an even greater risk.

“COVID-19 increases oxidative stress and inflammation and can affect the bradykinin pathway. All of these are also affected in obstructive sleep apnea patients. These mechanisms are already affected. If there are individuals, it is not surprising that COVID-19 affects them more strongly. “

Treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP) has been shown to have some beneficial effects on these mechanisms, optimizing treatment for these individuals. Is important. In the UK, the OSA Alliance’s British Sleep Society has published guidelines on the use of CPAP during pandemics.

Researchers feel that it is important for people diagnosed with obstructive sleep apnea to be aware of the potential additional risks and to take appropriate precautions to reduce their exposure to the virus. I am. Further investigation is needed to determine if these individuals need to be added to the list of vulnerable groups that need to be protected in the event of increased viral infection.

Dr. Miller further states: “This is a group of patients who should be more aware that obstructive sleep apnea may be an additional risk in the event of COVID-19. Make sure they adhere to treatment. And take as many precautions as possible to mitigate the risk. Now is the time to spend as hard as you can to follow your treatment plan more than ever.

“Hospitals and physicians also need to record whether patients have obstructive sleep apnea as a potential risk factor and should be included in COVID-19 study and outcome data. This is more worrisome. We need more data to decide if it should be done. “

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