Prevalence and Characteristics of Sleep Apnea in Intensive Care Unit Survivors After SARS-CoV-2 Pneumonia

Ibrahim Traore,1 Guillaume Eberst,1– 3 Fréderic Claudé,1 Lucie Laurent,1 Aurelia Meurisse,2,3 Sophie Paget-Bailly,2,3 Pauline Roux-Claudé,1 Pascale Jacoulet,1 Cindy Barnig,1 Rachel Martarello,1 Bastien Poirson,4 Kevin Bouiller,5 Catherine Chirouze,5 Julien Behr,6 Franck Grillet,6 Ophélie Ritter,1 Sébastien Pili-Floury,7 Hadrien Winiszewski,8 Emmanuel Samain,7,9 Gilles Capellier,8– 10 Virginie Westeel1– 3 1Respiratory Medicine Department, University Hospital of Besançon, Besançon, France; 2Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France; 3UMR 1098, University of Franche-Comté, Besançon, France; 4Department of Geriatrics, University Hospital of Besançon, Besançon, France; 5Department of Infectious Disease, University Hospital of Besançon, Besançon, France; 6Department of Radiology, University Hospital of Besançon, Besançon, France; 7Anesthesia and Intensive Care Unit, University Hospital of Besançon, Besançon, France; 8Medical Intensive Care Unit, University Hospital of Besançon, Besançon, France; 9Research Unit EA3920, Université de Franche Comté, Besançon, France; 10Australian and New Zealand Intensive Care Research Center, Department of Epidemiology and Preventive Medicine, Monash University, Monash, AustraliaCorrespondence: Ibrahim Traore, Respiratory Medicine Department, University Hospital of Besançon, Besançon, France, Email traore.ibrahim180@gmail.comBackground: Sleep apnea (SA) was reported as possibly exacerbating symptoms of COVID-19, a disease induced by SARS-CoV-2 virus. The same comorbidities are common with both pathologies. This study aimed to estimate the prevalence, characteristics of SA and variation in AHI three months after severe COVID-19 requiring intensive care unit (ICU) admission.Methods: A prospective cohort of patients admitted to ICU for severe COVID-19 underwent an overnight home polygraphy 3 months after onset of symptoms, as part of a comprehensive follow-up program (pulmonary function tests, 6-minute walk tests and chest CT-scan). Patients with an apnea hypopnea index (AHI) ≥ 5 were considered as having SA. We performed a comparative descriptive analysis of 2 subgroups according to the existence, severity of SA and indication for effective SA treatment: patients with absent or mild SA (AHI < 15) vs patients with moderate to severe SA (AHI ≥ 15).Results: Among 68 patients included, 62 (91%) had known comorbidities (34 hypertension, 21 obesity, 20 dyslipidemia, 16 type 2 diabetes). It has been observed a preexisting SA for 13 patients (19.1%). At 3 months, 62 patients (91%) had SA with 85.5% of obstructive events. Twenty-four patients had no or a mild SA (AHI < 15) and 44 had moderate to severe SA (AHI ≥ 15). Ischemic heart disease exclusively affected the moderate to severe SA group. Except for thoracic CT-scan which revealed less honeycomb lesions, COVID-19 symptoms were more severe in the group with moderate to severe SA, requiring a longer curarization, more prone position sessions and more frequent tracheotomy.Conclusion: SA involved 91% of patients in our population at 3 months of severe COVID-19 and was mainly obstructive type. Although SA might be a risk factor as well as consequences of ICU care in severe COVID-19 infection, our results underline the importance of sleep explorations after an ICU stay for this disease.Keywords: SARS-CoV-2, pneumonia, obstructive sleep apnea syndrome, intensive care unit