Undiagnosed sleep disorder breathing as a risk factor for critical COVID-19 and pulmonary consequences at the midterm follow-up

Labarca, Gonzalo; Henriquez-Beltran, Mario; Llerena, Faryd; Erices, Gustavo; Lastra., Jaime; Enos, Daniel; Castillo, Daniela; Fraga, Marco; Lamperti., Liliana; Ormazabal, Valeska; Riffo, Benilde; Rubilar, Daniel; Sanhueza, Rocio; Vasquez, Jaime; Villanueva, Carolina; Horta, Gloria; Sanhueza, Felipe; Melo, Pedro; Dreyse, Jorge; Jorquera, Jorge; Fernandez-Bussy, Sebastian; Gonzalez, Jessica; Barbe, Ferran; Nova-Lamperti, Estefania

INTRODUCTION: Patients with severe COVID-19 develops an acute respiratory distress syndrome (ARDS), requiring admission to the intensive care unit. COVID-19 also reports an increased prevalence of comorbidities, similar to patients with Sleep disorder breathing (SDB). OBJECTIVES: To evaluate the association between undiagnosed SDB and the risk of ARDS and pulmonary abnormalities in a cohort of patients’ survivors of COVID-19 between 3 to 6 months after diagnosis. METHODS: Prospective cohort study of patients who developed ARDS during hospitalization due to COVID-19 compared with a control group of patients who had COVID-19 with mild to moderate symptoms. All patients were evaluated between the 12(th) and 24(th) week after SARS-CoV-2 infection. The evaluation includes persistent symptoms, lung diffusing capacity of carbon monoxide (DLCO), chest CT scan and home sleep apnea test. SDB was diagnosed by the respiratory disturbance index ≥5 ev/h. The association between SDB and ARDS, the hazards of lung impairment and the hazard ratios (HR) were analyzed. RESULTS: A total of 60 patients were included (ARDS: 34 patients, Control: 26 patients). The mean follow-up was 16 weeks (range 12-24). ARDS reported a high prevalence of SDB (79% vs. 38% in control group). A total of 35% reported DLCO impairment, and 67.6% abnormal chest CT. SDB was independently associated to ARDS, OR 6.72 (CI, 1.56 – 28.93), p <0.01, and abnormal Chest CT, HR 17.2 (CI, 1.68 – 177.4, p=0.01). Besides, ARDS, days in mechanical ventilation, male gender were also associated with an increased risk of abnormal chest CT. CONCLUSION: Undiagnosed SDB is prevalent and independently associated with ARDS. In addition, undiagnosed SDB increased the hazard of abnormal Chest CT in the midterm. STUDY REGISTER: ISRCTN16865246.