High prevalence of obstructive sleep apnea in patients with Long-COVID

Long-COVID (LC) is defined as the persistence of symptoms 12 weeks after the acute COVID infection not explained by any other alternative diagnosis. Its pathophysiology is poorly understood. Obstructive Sleep Apnea (OSA) shares several clinical manifestations with LC, such as fatigue and low-quality sleep, however, thus far, their potential coexistence has been poorly addressed.

To investigate the prevalence of OSA in patients with LC.

Observational, prospective study. Patients with LC were recruited from a dedicated ambulatory hospital clinic. All patients underwent a comprehensive clinical evaluation, including standardized questionnaires to evaluate persistent symptoms, lung function tests and full polysomnography.

We studied 73 patients with LC. Their mean age was 57.4 ± 10.5 years, they were predominantly male (56.2%), 73.9% of whom were hospitalized during the acute COVID episode. Median AHI was 17.2 (24.14) events/h with a proportion of mild (27.4%), moderate (24.6%) and severe OSA (31.5%). Objective questionnaires identified poor sleep quality and fatigue as the most prevalent symptoms and daytime sleepiness as the least prevalent. Self-reported symptoms were frequent, with dyspnea, fatigue, and insomnia being the most commonly reported. Neither objective nor subjective symptoms correlated with OSA severity, with the exception of insomnia.

In this single-center, clinic-based LC cohort, OSA diagnosed by in-lab PSG was highly common. Given that OSA is treatable, a sleep study should be considered in LC patients even in the absence of daytime sleepiness or in the presence of insomnia.