RESEARCH ARTICLE


Association of Diagnosed Obstructive Sleep Apnea with Hospitalization and Mortality in a Retrospective New York City COVID-19 Surge Cohort with a Risk Prediction Model



Mindaugas Pranevicius1, 6, *, Afshin Parsikia2, Leon Golden1, Maria Castaldi3, James P. Casper4, Jody Kaban5, Roxane Todor5, Osvaldas Pranevicius6
1 Department of Anesthesiology Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pk. SBronx, NY 10461, USA
2 Department of Surgery, Einstein Healthcare Network, Philadelphia, PA, USA
3 Westchester Medical Center, New York Medical College Albert Einstein College of Medicine, Valhalla, NY 19595, USA
4 New York Medical College, New York, USA
5 Department of Surgery, Jacobi Medical Center, Bronx NY 10461, USA
6 New York Presbyterian QueensTeam Health Anesthesia, 56-45 Main St. Queens, NY 11355, USA


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Creative Commons License
© 2022 Pranevicius et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Albert Einstein College of Medicine, Department of AnesthesiologyJacobi Medical Center1400 Pelham Pk. SBronx, NY 10461; Tel: 917-699-9942; E-mail: mindaugas.praneviciu@nychhc.org


Abstract

Background:

COVID-19 infection is more severe in patients with obstructive sleep apnea (OSA) with unclear modification by risk factors. Additionally, there is no scoring algorithm for probability of admission.

Methods:

On 8/4/2020 we queried New York City Health and Hospitals system database for patients above 15 years old who tested positive for COVID-19 during the surge. The target was diagnosed OSA. The timeframe was between 3/24/2020 and 6/7/2020 with limited elective hospital admissions. We calculated case-control-matched odds ratios for admission, intubation, and death. Additionally, we introduced a scoring system to predict the probability of admission due to COVID19 infection in the presence of OSA and other comorbidities.

Results:

Out of 19,593 COVID positive patients 306 (1.6%) had documented OSA. On multivariate analysis, the adjusted odds ratios for patients with OSA were 2.04 (CI 1.32-3.16, p 0.001) for admission, 1.05 (0.73-1.52, p 0.784) for intubation and 1.23 (CI 0.95-1.61, p 0.122) for mortality. After matching and comparing to a randomly selected non-OSA patients, the adjusted odds ratio for the same outcomes were 2.21 (1.41-3.46, p <0.001)-admission, 1.28 (0.83-1.98, p 0.256)-intubation and 1.69 (1.24-2.28, p<0.001)-mortality. Per our developed 11-point scoring algorithm, the risk of admission for these patients is almost 90% when the summation of points is as a low as 4 out of 11.

Conclusion:

Diagnosis of OSA is associated with hospital admission and mortality in COVID patients. This should be considered during triage and therapy decisions. Presented scoring model for estimated risk of admission could serve as a quantitative tool to estimate risk of admission.

Keyword: COVID, OSA, Risk, Factor, Model, Sleep apnea.