Sleep Apnea Pathophysiology in Patients with a History of COVID-19

Background: Emerging evidence suggests that COVID-19 may influence obstructive sleep apnea (OSA) pathophysiology by affecting upper airway collapsibility, ventilatory control, and arousal responses, raising the possibility of a bidirectional relationship. This study examined whether individuals with a history of COVID-19 show altered OSA-related physiological traits compared with those without prior infection. Methods: In a case-control study, 60 participants with a history of COVID-19 were compared to 60 matched controls who underwent overnight in-hospital polysomnography before the pandemic. The matching criteria included age (±5 years), gender, body mass index (BMI) (±5 kg/m²), and OSA presence. Key pathophysiological traits (collapsibility, loop gain, arousal threshold, muscle compensation) estimated from polysomnographic signals were compared, with adjustment for age, sex, BMI, and apnea-hypopnea index. Results: The participants (78% male, mean age 55 ± 12 years, BMI 29.4 ± 5.0 kg/m²) exhibited no meaningful differences in their average levels of collapsibility (Adj dif [95% CI]; V_passive: -1 [-4, 2] %_eupnea, p = 0.7), loop gain (LG₁: 0.01 [-0.04, 0.06], p = 0.7), or arousal threshold levels (-1 [-7, 4] %_eupnea) and showed similar levels of muscle compensation (V_comp: 5 [-1, 11], p = 0.12). However, a greater ventilatory response to arousal (7 [1, 12] %_eupnea) was associated with COVID-19 history. Conclusions: COVID-19 history is not associated with differences in key OSA pathophysiological traits, suggesting it is unlikely to explain observed differences in OSA presentation. The increased ventilatory response to arousal may have implications for treatment responses and outcomes.