LETTER TO THE EDITOR |
https://doi.org/10.5005/jp-journals-11010-1147 |
Undiagnosed Sleep Apnea: Exacerbating the Postcoronavirus Disease Symptoms?
1–4Department of Central Research Facility, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
Corresponding Author: Poonam Suryawanshi, Department of Central Research Facility, Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India, Phone: +91 8805026344, e-mail: poonam.suryawanshi@dpu.edu.in
How to cite this article: Takbhate R, Patil-Takbhate B, Tripathy S, et al. Undiagnosed Sleep Apnea: Exacerbating the Postcoronavirus Disease Symptoms? Indian J Respir Care 2024;13(4):271–272.
Source of support: Nil
Conflict of interest: None
Dear Editor,
After acute coronavirus disease 2019 (COVID-19) infections, many patients are experiencing post-COVID complications because of undiagnosed conditions like sleep apnea. Obstructive sleep apnea (OSA) is a sleeping disorder wherein the patient stops breathing temporarily and starts breathing again during the sleep cycle.1 It is observed that it happens because of muscle relaxation of the throat and/or when the tongue falls back of the throat and obstructs the airways partially and/or completely along with decreased oxygen saturation, and the patient wakes up frequently from sleep.2
When a patient is infected with COVID-19 and experiences continued symptoms of fatigue, daytime sleepiness, or sleep disturbance for >3 months, the patient is suffering from post-COVID or long COVID syndrome.3 As the causes of these symptoms are unclear, polysomnography (PSG) study is performed for patients having post-COVID symptoms, and it is found that sleep apnea may increase the risk of long COVID in adults by as much as 75%.1 It is also found in studies that patients having OSA, when infected with COVID, have exacerbated COVID symptoms.4
When a patient with undiagnosed sleep apnea is infected with COVID-19 and exhibits symptoms of daytime drowsiness, exhaustion, and memory/concentration difficulties, it may be due to reduced sleep efficiency. Undiagnosed sleep apnea can cause reduced sleep efficiency, tiredness, and other symptoms in COVID-19 patients.4
Sleep apnea does not appear to increase the chance of getting COVID-19, but individuals with undiagnosed or untreated sleep apnea have a significant risk of aggravating COVID-19 symptoms. OSA along with COVID-19 affects the patient’s sleep quality as it disturbs the sleep with frequent arousals from sleep to fall asleep again to establish a normal breathing pattern. As COVID-19 causes nasal congestion, which can restrict the airflow, it does not cause OSA in the patient.5 Sleep apnea may substantially raise the risk of developing long COVID in adults, according to a study conducted by the National Institutes of Health’s RECOVER Initiative. Previous research has indicated that individuals with OSA often experience more severe outcomes during the initial stages of COVID-19 infection. OSA, which affects approximately one in eight adults, is frequently underdiagnosed.6
On the contrary, it is found that almost two-thirds of participants have a higher prevalence of sleep apnea during SARS-CoV-2 infection, requiring oxygen support in 52% of patients and 48% of patients requiring invasive and noninvasive ventilation.5 Furthermore, when 3,762 individuals are studied for around 7 months, it is shown that there is considerable cognitive damage after 6 months of COVID infection, suggesting undiagnosed/untreated sleep apnea.6 It is found that there is neurological impairment associated with OSA. Sleep deprivation with OSA is often associated with a higher possibility of viral infections.4 Below figure shows the interaction between COVID-19 and sleep apnea (Fig. 1).
Fig. 1: Shows the impact of COVID-19 with sleep apnea
The generation of T cell interleukin-2, as well as disruption of the renin-angiotensin system, increases the onset of inflammatory activity, potentially promoting viral pneumonia.
Similarly, on the contrary, during COVID-19 infection, OSA may cause pathophysiologically higher synergic levels of hypoxemia, which complement activation of a severe cytokine storm as well.4 Continuous positive airway pressure (CPAP) therapy used for sleep apnea has initial concerns about increasing the risk of transmission to others. This necessitated careful management and possible changes to treatment protocols.
In conclusion, diagnosing sleep apnea is critical for precise treatment of post-COVID-19 symptoms. Maintaining proper sleep apnea treatment and following COVID-19 preventive measures are essential steps to protect one’s health. Regardless of the cause or onset of OSA in post-COVID patients, a diagnosis of OSA accompanied by sleep disturbances or daytime sleepiness warrants a trial of treatment.
ORCID
Bhagyashri Patil-Takbhate https://orcid.org/0009-0002-7996-3012
Srikanth Tripathy https://orcid.org/0000-0002-8363-2606
Poonam Suryawanshi https://orcid.org/0000-0002-4352-5339
REFERENCES
1. Menzler K, Mayr P, Knake S, et al. Undiagnosed obstructive sleep apnea syndrome as a treatable cause of new-onset sleepiness in some post-COVID patients. Eur J Neurol 2024;31(3):e16159. DOI: 10.1111/ene.16159
2. Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397(10270):220–232. DOI: 10.1016/S0140-6736(20)32656-8
3. Higgins V, Sohaei D, Diamandis EP, et al. COVID-19: from an acute to chronic disease? Potential long-term health consequences. Crit Rev Clin Lab Sci 2021;58(5):297–310. DOI: 10.1080/10408363.2020.1860895
4. Fernández-De-Las-Peñas C, Torres-Macho J, Elvira-Martínez CM, et al. Obesity is associated with a greater number of long-term post-COVID symptoms and poor sleep quality: a multicenter case-control study. Int J Clin Pract 2021;75:e14917. DOI: 10.1111/ijcp.14917
5. Koczulla AR, Stegemann A, Gloeckl R, et al. Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports. J Med Case Rep 2021;15:211. DOI: 10.1186/s13256-021-02819-0
6. https://nyulangone.org/news/sleep-apnea-associated-increased-risk-long-covid.
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