681 Sleep Apnea Severity and COVID-19 Hospitalization Outcomes: Interim Analysis

Mansour, Wissam; Knauert, Melissa

INTRODUCTION: Millions worldwide have been infected with COVID-19. Risk factors for poor outcomes include older age, obesity, cardiovascular disease, diabetes, COPD, and minority ethnicity. The impact of sleep apnea (OSA) on COVID-19 illness remains a topic of ongoing research. The association seems plausible as OSA shares common risk factors with COVID-19 comorbidities. The aim of our study is to investigate if the severity of OSA correlates with COVID-19 hospitalization outcomes. METHODS: The study is an observational retrospective electronic medical chart review of patients admitted to the Yale Health system for COVID-19 illness, who have an ICD medical history diagnosis of sleep apnea. Subjects with an available sleep study were grouped based on AHI severity. Composite outcome was determined by mortality or critical illness (ICU admission, mechanical ventilation, High-Flow nasal cannula or noninvasive ventilation). Interim analysis was conducted with data from 256 patients. Logistic regression was performed to calculate OR associated with the primary outcome comparing mild versus moderate-severe OSA groups. RESULTS: The sample of 256 patients included 50% females, with a median age of 64 (IQR,55–73) and BMI of 36 (IQR,30–41). Race distribution composed of 45% Whites and 40% African-Americans with 18% identifying as Hispanic. Overall mortality rate was 16%. Median length of stay (LOS) was 9 days (IQR,5 -15). 155 patients had a recorded AHI with a median of 26/hour (IQR,11–51) grouped into mild (34%), moderate (20%) and severe (45%) disease. Severe sleep apnea had the highest mortality rate of 19% and median LOS of 10 days (IQR,5- 16) compared to moderate (6% mortality,9 days (IQR,6–14)) and mild (17% mortality,6 days (IQR,4–11)) disease; differences were not statistically significant. Univariate logistic regression analysis demonstrated no significant difference in the composite outcome for mild versus moderate-severe OSA groups (OR=1.2; 95% CI:0.58–2.32). CONCLUSION: Severe OSA appeared to have a trend towards an association with higher mortality versus moderate but not mild disease. Comparing moderate-severe disease to a reference group of mild disease did not demonstrate a significant difference in our composite outcome of death or critical illness. Additional subject recruitment and re-analysis are needed to confirm the findings of this interim analysis. SUPPORT (IF ANY): N/A