Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes

Session Title
A1108 - Impact of Obstructive Sleep Apnea and Positive Airway Pressure Therapy on COVID-19 Outcomes
Author Block: D. Hwang1, J. Shi2, A. Chen2, J. Arguelles1, K. A. Becker1, J. B. Kim1, R. R. Woodrum3, K. Valentine4, A. Benjafield5; 1Sleep Medicine, Kaiser Permanente, Fontana, CA, United States, 2Research and Evaluation, Kaiser Permanente, Pasadena, CA, United States, 3Sleep Medicine, Kaiser Permanente, Fontana, Fontana, CA, United States, 4Medical Affairs, ResMed Corp, San Diego, CA, United States, 5Medical Affairs, ResMed, Sydney, Australia.
Introduction We explore potential impact of obstructive sleep apnea (OSA) and positive airway pressure (PAP) therapy on novel coronavirus (COVID-19) infection rate and severity. Methods Retrospective analysis was performed utilizing a database of patients evaluated by Kaiser Permanente Southern California sleep medicine between 2015-2020 that includes sleep study data, remotely collected daily PAP data, and electronic health record information. Adult patients were included for analysis if: a) healthplan enrollment was before February 1, 2020; b) as of March 1, 2020 patient was alive and had either sleep diagnostic or PAP data. PAP adherence was calculated between March 1, 2020 to COVID-19 confirmation, death, disenrollment or study end date (July 31, 2020), whichever came earlier. COVID-19 infection rates and all-cause hospitalizations and mortality were evaluated based on OSA status and PAP adherence utilizing these definitions: patients <2 hours/night PAP were considered “untreated” and ≥2 hours/night were “treated”; 2-3.9 hours/night were “moderately treated” and ≥4 hours/night were “well treated”. Apnea hypopnea index (AHI) was used to define OSA severity. Multiple logistic regression evaluated the association of various demographic and clinical factors. Results 81,932 patients (39.8% female, age 54.0±14.9 years, 9.9% Black and 34.5% Hispanic) met inclusion for analysis. 1493 (1.8%) had confirmed COVID-19 infection with 224 (0.3%) hospitalizations and 61 (0.07%) resulting in intensive care or death. “Untreated” OSA (and increasing OSA severity) was associated with higher COVID-19 rate and lower rate when “treated” [No OSA 1.7%; "Untreated" Mild 2%, Moderate 2%, Severe 2.4%, OSA unknown severity 2%; "Treated" 1.4%; p<0.0001]. Stratifying PAP adherence also demonstrated reduced infection rate with greater use [“untreated” 2.1%; “moderately treated” 1.7%, “well treated” 1.3%, No OSA 1.7%; p<0.0001]. Multivariable analysis (See FIGURE) confirmed higher infection rate with OSA versus no OSA [OR 0.82(0.70,0.96)] and the benefit of PAP versus “untreated” [“moderately treated” OR 0.82 (0.65, 1.03); “well treated” OR (0.69 (0.59, 0.80)]. Obesity, higher Charlson Comorbidity score, Black and Hispanic ethnicities, and Medicaid enrollment were also associated with higher infection rates; increasing age was associated with reduced infection rate. Separate multivariable analysis showed dose-response association of OSA severity on infection rate [Mild OR 1.21 (1.01,1.44 95%CI); Moderate-Severe OR 1.27 (1.07,1.51) versus no OSA]. Neither OSA presence nor PAP adherence significantly impacted hospitalization rate nor intensive care/death. Conclusion Significant associations emerged with OSA increasing and PAP therapy reducing COVID-19 infection rate. Findings suggest both biologic and social-behavioral influences while also supporting continued PAP use during the pandemic.