Obstructive Sleep Apnea and COVID-19 Infection Comorbidity: Analysis of the Problem in the Age Aspect

International Journal of Biomedicine 10(4) (2020) 312-315 http://dx.doi.org/10.21103/Article10(4)_RA1 COVID-19 Infection INTERNATIONAL JOURNAL OF BIOMEDICINE BRIEF REVIEW Obstructive Sleep Apnea and COVID-19 Infection Comorbidity: Analysis of the Problem in the Age Aspect Olga Berdina, PhD*; Irina Madaeva, PhD, ScD; Lyubov Rychkova, PhD, ScD, Corresponding Member of the RAS Scientific Centre for Family Health and Human Reproduction Problems Irkutsk, the Russian Federation Abstract In the literature, there are suggestions of a possible mutual influence between obstructive sleep apnea (OSA) and the novel coronavirus disease 2019 (COVID-19).The aim of this review is to analyze data found in the literature related to pathogenetic aspects of the impact of OSA on COVID-19, and vice versa, and features of the course of this comorbidity in both adulthood and childhood. Information was searched in MEDLINE, PubMed, EBSCO, and RSCI databases, which presented some data for the connection between COVID-19 and OSA, as well as aspects of OSA and COVID-19 comorbidity for adults and the elderly. The common pathophysiological pathways leading to increased systemic inflammation and adverse consequences of OSA and COVID-19 infection do coexist and were revealed in detail. We paid special attention to aspects of this comorbidity in children, and found that research in this area was lacking. Based on this information, it should be concluded that: 1) more pediatric studies of links between OSA and COVID-19 are urgently needed; 2) screening hospitalized COVID-19 patients with tools to detect OSA could identify those at risk for a severe course of these diseases and adverse outcomes; 3) treating OSA will allow increasing the likelihood of developing a robust and long-lasting post-COVID-19 adaptive immunity in these patients. (International Journal of Biomedicine. 2020;10(4):312-315.) Key Words: obstructive sleep apnea • COVID-19 • comorbidity • pathogenesis • adults • children J ust over half a year has passed since the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern. At the time, there were only 100 cases outside of China and no deaths. Since then, the incidence has been increasing exponentially, affecting every country in the world. WHO data, published on August 16, 2020, reported 21,294,845 cases of COVID-19 worldwide, with 761,779 deaths, but on September 21, 2020, reported 30,949,804 cases in 235 countries, and 959,116 deaths.(1) The number of new cases of COVID-19 increases week by week and reaches 2,000,000 per week (Fig.1).(2) In the Russian Federation as of September 21, 2020, the number of cases of COVID-19 infection was 1,109,595, with 6,196 deaths.(3) The COVID-19 pandemic has placed an enormous burden on the global health care system *Corresponding author: Olga Berdina, PhD, MD. Leading researcher, Laboratory of Somnology and Neurophysiology, Scientific Сentre for Family Health and Human Reproduction Problems; Irkutsk, Russia. E-mail: with numerous consequences. The secondary effects of this pandemic, along with major disruptions to essential health care services, are having a huge impact on politics, the economy, and people’s daily lives. Fig. 1. Number of COVID-19 cases reported weekly by worldwide and global deaths, December 2019 through September 2020 (adapted from (2). O. Berdina et al. / International Journal of Biomedicine 10(4) (2020) 312-315 COVID-19 was predominantly more prevalent among adults and the elderly at the beginning of the outbreak, and the percentage of confirmed cases among children and adolescents was relatively small. The Chinese Novel Coronavirus Pneumonia Emergency Response Epidemiology Team reported that about 2% of 44,672 confirmed cases of COVID-19 in China through February 11, 2020, were children between 0 and 19 years of age;(4) of these, 0.9% were subjects younger than 10 years old. One month later in Italy, Livingston et al. found that 1.2% of all confirmed cases (22,512) of COVID-19 were children, with no deaths.(5) At the same time, of 4,226 COVID-19 cases detected in the United States, 5% were children.(6) Importantly, more than 90% of ill children were asymptomatic or had mild or moderate symptoms of COVID-19 infection. Since then, the number of child COVID-19 cases has increased significantly, especially in younger age groups, and the disease increasingly began to manifest with so-called «pediatric multisystem inflammatory syndrome»(7) with severe outcomes;(8) therefore, high attention and care should be directed to children and adolescents with COVID-19, just like adult patients. It was shown that COVID-19 is an acute, self-limiting disease, but some patients can die, according to Xu’s et al. reported mortality rate of 2% in adults.(9) The Centers for Disease Control and Prevention (CDC) has published data of deaths involving COVID-19 with a focus on ages 0-18 years in the United States, and on August 26, 2020, reported that in the US there were 29 deaths among children aged 0-4 and 65 among those aged 5-18 years.(10) Some studies have reported a higher COVID-19 incidence in men than in women (0.31/100,000 vs 0.27/100,000, respectively).(11) Wherein, the case mortality rate for males was also higher than for females (2.8% vs 1.7%, respectively), with a similar trend in children and adolescents, reported by the CDC in the US.(10) It has also been proven that the risk of infection and complications increases significantly in the presence of comorbidities (both adults and children): Patients who reported no comorbid diseases had lower mortality rates than those with comorbid conditions, such as cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, or cancer.(4,12) All of the above-mentioned prompted us to closely study the features of the pathogenetic mechanisms and relationships between COVID-19 and one comorbidity, namely OSA, that is very important for the health care of both adults and children. It should be noted that, despite the obvious relevance and severity of this problem worldwide and numerous discussions in the foreign literature, there are many works of Russian scientists about COVID-19 infection and coexisting diseases in adults,(13,14) while only one publication is devoted to the association between COVID-19 and OSA.(15) But there are no Russian publications, and just a single foreign one, on this problem in pediatric patients. The aim of this review is to analyze data found in the literature related to pathogenetic aspects of the impact of OSA on COVID-19, and vice versa, and features of the course of this comorbidity in both adulthood and childhood. Information was searched in MEDLINE, PubMed, EBSCO, and RSCI databases. OSA and COVID-19 infection in adults and the elderly By definition, OSA is a condition characterized by 313 recurrent episodes of upper airway obstruction during sleep, due to anatomical narrowing of the airway, (...truncated)