People with Sleep Apnea May Have Higher Risk of Severe COVID-19

People with Sleep Apnea May Have Higher Risk of Severe COVID-19By Dr. Anuj Chandra, Advanced Center for Sleep Disorders

(September 28, 2020) — People with obstructive sleep apnea (OSA) could have higher risk of severe COVID-19, according to new research.

Obstructive sleep apnea occurs when the tissues in a sleeper’s throat collapse slightly, causing obstruction to the airflow into and out of the body. The result is temporary breathing stoppages that sound like snorting or audible pauses. (Snoring, in contrast, is usually quieter and is caused by slight vibration of the same throat tissues.) OSA can cause hundreds of these pauses throughout the night — contributing to serious health problems such as high blood pressure, heart attack, stroke, diabetes, and depression — but the connection to COVID-19 is just now beginning to be seen in research.

Although obstructive sleep apnea is not currently on the Center for Disease Control and Prevention list of “underlying conditions” that contribute to more severe outcomes with COVID-19, a systematic scientific review of published studies, published in September in the journal Sleep Medicine Reviews, concludes that people with OSA could be at increased risk from COVID-19. The study analyzed 18 previous studies reporting outcomes for COVID-19 patients that were also diagnosed with OSA.

One of the studies looked at people with diabetes who were hospitalized for COVID-19. It found that those who were being treated for OSA were more than two and a half times as likely to die by the seventh day in the hospital.

What Can Be Done?

People with sleep apnea need to be aware that they could be at increased risk and take precautions to reduce their exposure to the coronavirus, such as masking, social distancing, and avoiding crowds of people.

Many people receiving treatment for sleep apnea have a hard time sleeping at night with a CPAP (continuous positive airway pressure) machine, one of the most common treatments for OSA. Sleep specialists like me need to work aggressively with those patients to help them stay compliant with their treatment plan.

People with undiagnosed OSA are also a big concern. This review of published studies only included people who have been diagnosed, but we know that at least 80 percent of people with OSA are undiagnosed worldwide. They don’t know they are at risk because of the effects of sleep apnea itself, and they don’t know they are at higher risk for severe COVID-19. The earlier we can diagnose and treat them, the better.

Even though the pandemic has caused many people to delay treatment for various conditions, anyone who has been diagnosed with OSA should begin receiving treatment, and anyone who suspects they might have OSA — often because their bed partner hears them stop breathing — should be tested for sleep apnea.

Hospitals need to start screening patients hospitalized with COVID-19 to identify people whose OSA might put them at higher risk for adverse outcomes.

Finally, everyone needs to do everything they can to get healthy, restorative sleep. Dealing with this pandemic is extremely stressful. Many people are not sleeping well. But losing sleep makes it harder for your immune system to work effectively. Good sleep is essential to keeping your immune system strong.

Anuj Chandra, M.D., D.ABSM, founded the Advanced Center for Sleep Medicine in 2005, an independent sleep medicine clinic equipped with the latest sleep testing equipment and with locations in and around Chattanooga, Tennessee. Since 2005, Dr. Chandra has served on the international teaching faculty of the National Sleep Medicine Course, a physician education initiative to bring cutting edge sleep medicine training to India. For more on Dr. Chandra and the Advanced Center for Sleep Medicine, visit

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