Obstructive sleep apnea might be at increased risk of infection if not treated because uncontrolled inflammation in the airway decreases defense mechanisms and increases micro-aspiration. However, there are no published data on OSA as a risk factor for the infection.

Obstructive sleep apnea patients often share the increased risk factors for a more severe form of COVID-19 namely, they are more likely to be obese (Body mass index above 30, calculate your body mass index at https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm), to have diabetes, cardiovascular disease, and chronic lung disease than those without OSA therefore, one would suspect an increase in severity of the infection. However, there are no published data except for a single study in a diabetic French population of hospitalized patients.

In the CORONADO study (Cariou, Diabetologia 2020 Aug;63(8):1500-1515. doi: 10.1007/s00125-020-05180-x. Epub 2020 May 29), among 1307 diabetic individuals (88% type 2, mean age of 70) hospitalized for COVID-19, a third required Intensive Care Unit admission and 11% were deceased at 7 days. Obstructive sleep apnea was associated with an increase in death at 7 days by 3-fold. Age and obstructive sleep apnea were the 2 strongest predictors of early death. In that study, obstructive sleep apnea and not body mass index (an indirect measure of obesity) was predictive of a poor outcome. This is to stress that the multiple other studies that considered only Body Mass Index as a risk factor for severe COVID-19 but which did not look for obstructive sleep apnea per se, might just have missed the point that it is not the mere increase in fatty tissues but the hidden obstructive sleep apnea that is the culprit.

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