Obstructive sleep apnea: a major risk factor for COVID-19 encephalopathy?

Gautier Breville; François Herrmann; Dan Adler; Christine Deffert; Giulia Bommarito; Patrick Stancu; Alice Accorroni; Marjolaine Uginet; Frederic Assal; Renaud Tamisier; Patrice H Lalive; Jean-Louis Pepin; Karl-Olof Lövblad; Gilles Allali

doi:10.1186/s12883-023-03393-2

Obstructive sleep apnea: a major risk factor for COVID-19 encephalopathy?

BMC Neurol. 2023 Sep 27;23(1):340. doi: 10.1186/s12883-023-03393-2.

Authors

Gautier Breville^{1

2}, François Herrmann³, Dan Adler⁴, Christine Deffert^{5

6}, Giulia Bommarito⁷, Patrick Stancu⁸, Alice Accorroni⁸, Marjolaine Uginet⁸, Frederic Assal⁸, Renaud Tamisier⁹, Patrice H Lalive^{8

10

11}, Jean-Louis Pepin^{4

9}, Karl-Olof Lövblad¹², Gilles Allali^{8

7

13}

Affiliations

¹ Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. gautier.breville@pennmedicine.upenn.edu.
² Department of Neurosciences, Division of Neurology, Geneva University Hospitals, Geneva, Switzerland. gautier.breville@pennmedicine.upenn.edu.
³ Department of Rehabilitation and Geriatrics, Division of Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
⁴ Division of Pneumology, La Tour Hospital, Geneva, Switzerland.
⁵ Laboratory of Biological Fluids, Laboratory Medicine Division, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
⁶ Laboratory Medicine Division, Department of Medical Specialties, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁷ Leenaards Memory Center, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
⁸ Department of Neurosciences, Division of Neurology, Geneva University Hospitals, Geneva, Switzerland.
⁹ Univ. Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, 38000, Grenoble, France.
¹⁰ Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹¹ Diagnostic Department, Division of Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹² Division of Neuroradiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
¹³ Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.

Abstract

Background: This study evaluates the impact of high risk of obstructive sleep apnea (OSA) on coronavirus disease 2019 (COVID-19) acute encephalopathy (AE).

Methods: Between 3/1/2020 and 11/1/2021, 97 consecutive patients were evaluated at the Geneva University Hospitals with a neurological diagnosis of COVID-19 AE. They were divided in two groups depending on the presence or absence of high risk for OSA based on the modified NOSAS score (mNOSAS, respectively ≥ 8 and < 8). We compared patients' characteristics (clinical, biological, brain MRI, EEG, pulmonary CT). The severity of COVID-19 AE relied on the RASS and CAM scores.

Results: Most COVID-19 AE patients presented with a high mNOSAS, suggesting high risk of OSA (> 80%). Patients with a high mNOSAS had a more severe form of COVID-19 AE (84.8% versus 27.8%), longer mean duration of COVID-19 AE (27.9 versus 16.9 days), higher mRS at discharge (≥ 3 in 58.2% versus 16.7%), and increased prevalence of brain vessels enhancement (98.1% versus 20.0%). High risk of OSA was associated with a 14 fold increased risk of developing a severe COVID-19 AE (OR = 14.52).

Discussion: These observations suggest an association between high risk of OSA and COVID-19 AE severity. High risk of OSA could be a predisposing factor leading to severe COVID-19 AE and consecutive long-term sequalae.

Keywords: COVID-19 encephalopathy; Obstructive sleep apnea; SARS-CoV-2.

MeSH terms

Brain Diseases* / complications
Brain Diseases* / diagnostic imaging
Brain Diseases* / epidemiology
COVID-19* / complications
COVID-19* / epidemiology
Humans
Polysomnography
Risk Factors
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / epidemiology