Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults

Stuart F. Quan, Matthew D. Weaver, Mark Czeisler, Laura K. Barger, Lauren A. Booker, Mark E. Howard, Melinda L. Jackson, Rashon Lane, Christine F. McDonald, Anna Ridgers, Rebecca Robbins, Prerna Varma, Shantha M.W. Rajaratnam, Charles A. Czeisler

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3 Citations (Scopus)


Study Objectives: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? Methods: This was a cross-sectional survey of a diverse sample of 15,057 US adults. Results: COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39–1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17–2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. Conclusions: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization.

Original languageEnglish
Pages (from-to)1303-1311
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number7
Publication statusPublished - 1 Jul 2023

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