Obstructive sleep apnea: a major risk factor for COVID-19 encephalopathy?

Area of Science:

• Neurology
• Infectious Diseases
• Sleep Medicine

Background:

• Coronavirus disease 2019 (COVID-19) can cause acute encephalopathy (AE).
• Obstructive sleep apnea (OSA) is a common sleep disorder.
• The relationship between OSA risk and COVID-19 AE severity is not well understood.

Purpose of the Study:

• To evaluate the impact of high risk of obstructive sleep apnea (OSA) on the severity of COVID-19 acute encephalopathy (AE).

Main Methods:

• 97 patients with COVID-19 AE were assessed between March 2020 and November 2021.
• Patients were grouped by high risk of OSA (modified NOSAS score ≥ 8) versus low risk (mNOSAS < 8).
• Clinical, biological, neuroimaging (MRI), EEG, and CT findings were compared. AE severity was assessed using RASS and CAM scores.

Main Results:

• Over 80% of COVID-19 AE patients had a high risk of OSA (mNOSAS ≥ 8).
• High OSA risk patients showed more severe COVID-19 AE (84.8% vs 27.8%), longer AE duration (27.9 vs 16.9 days), and higher disability at discharge (mRS ≥ 3 in 58.2% vs 16.7%).
• High OSA risk was associated with a 14.5-fold increased risk of severe COVID-19 AE and a higher prevalence of brain vessel enhancement (98.1% vs 20.0%).

Conclusions:

• A significant association exists between a high risk of OSA and increased severity of COVID-19 AE.
• High risk of OSA may be a predisposing factor for severe COVID-19 AE.
• This association suggests potential long-term sequelae in patients with both conditions.