目的:阻塞性睡眠呼吸暂停(OSA)与更严重的急性冠状病毒病-2019(COVID-19)结局相关。我们评估了OSA是SARS-CoV-2(PASC)急性后遗症的潜在危险因素。
方法:我们使用来自多个研究网络的电子健康记录数据评估了先前存在的OSA对成人和儿童可能的PASC风险的影响。重新搜索COVID以增强恢复倡议内的三个研究网络(PCORnet成人,PCORnet儿科,和国家COVID队列协作[N3C])采用统一的分析方法来检查在大流行发作之前有或没有OSA诊断的COVID-19阳性患者中可能的PASC风险。计算未调整的赔率比(ORs),并根据年龄组调整ORs,性别,种族/民族,住院状态,肥胖,和先前存在的合并症。
结果:跨网络,在成人和儿童中,与先前存在OSA诊断相关的可能PASC的未校正OR为1.41~3.93.调整后的分析发现,仅在成年人中存在减弱的关联。具有扩展的纳入标准和协变量的多重敏感性分析得出的结果与主要分析一致。
结论:发现预先存在OSA的成年人发生PASC的几率显著升高。这一发现在不同数据源之间是一致的,鉴定COVID-19阳性患者的方法,以及PASC的定义。SARS-CoV-2感染后,OSA患者发生PASC的风险可能会升高,应监测急性后遗症。
Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC).
We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities.
Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis.
Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.