Risk of new-onset obstructive sleep apnea up to 4.5 years after COVID-19 in the urban population

Obstructive sleep apnea (OSA) is linked to cardiovascular, metabolic, and cognitive morbidity. Although COVID-19 has been associated with long-term respiratory and neurological sequelae, its role in precipitating new-onset OSA remains unclear. We evaluated whether SARS-CoV-2 infection increases risk of developing OSA up to 4.5 years post-infection and how risk varies by hospitalization status, demographics, comorbidities, and vaccination status. This retrospective cohort study used electronic health records from the Montefiore Health System in the Bronx. Adults tested for SARS-CoV-2 between March 1, 2020, and August 17, 2024, were classified as hospitalized COVID+ , non-hospitalized COVID+ , or COVID- . Patients with prior OSA or loss to follow-up were excluded. Inverse probability weighting adjusted for demographic, clinical, socioeconomic, and vaccination covariates. New-onset OSA was assessed using weighted Cox proportional hazards models. Secondary outcomes including hypertension, myocardial infarction, heart failure, stroke, arrhythmia, pulmonary hypertension, type 2 diabetes, and obesity of individuals who developed new-onset OSA were evaluated with Poisson regression. Sensitivity analysis used a pre-pandemic control cohort. Among 910,393 eligible patients, hospitalized [HR 1.41 (95% CI 1.14-1.73)] and non-hospitalized [HR 1.33 (95% CI 1.22-1.46)] COVID+ patients had higher adjusted risk of new-onset OSA versus COVID- controls. Similar findings were observed when compared to the historical controls (n = 621,046). After OSA onset, hospitalized COVID+ patients had higher risks of heart failure and pulmonary hypertension, while non-hospitalized COVID+ patients had higher risk of obesity vs COVID- patients. SARS-CoV-2 infection is independently associated with increased risk of new-onset OSA. These findings support targeted screening post-COVID in high-risk populations.