In a recent analysis, data showed a relationship between severe COVID-19 and obstructive sleep apnea (OSA), making this the first study that clarifies the relationship between OSA and COVID-19 risk. using 2-sample bidirectional Mendelian randomization (MRI).1 This study also provides a better understanding of OSA and COVID-19 as it is important for disease prevention and the development of therapeutic approaches.
The inverse variance-weighted (IVW) mode in RM analysis demonstrated that COVID-19 was correlated with a 4.9% higher risk of OSAS (OR, 1.049; 95% CI, 1.018-1.081; P = 0.002), which was consistent in the residual sum and outlier of MR pleiotropy (MR-PRESSO) (OR, 1.049; 95% CI, 1.018-1.081; P = 0.004), weighted median (OR, 1.048; 95% CI, 1.003-1.095; P = 0.035), and MR-Egger regression (OR, 1.083; 95% CI, 1.012-1.190; P = 0.041).1
Study investigator Xiang Gao, MD, Department of Ear, Nose and Throat Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, and colleagues wrote, “There is no significant evidence to support for a causal association between OSA and any COVID phenotype, as we identified potential evidence for a causal effect of severe COVID-19 on an increased risk of OSA.
In the assessment of the causal relationship between OSA and COVID-19, MR was used and selected single nucleotide polymorphisms for instrumental variables from genome-wide association studies. The IVW method was selected as the primary approach for data analysis to estimate possible causal effects, while the MR-Egger and MR-PRESSO were used for sensitivity analysis that would yield the robustness of the results .
The results of the MR analyzes also showed no statistically significant evidence with the IVW mode for the causal relationship between OSA and COVID-19 (OR, 0.984; 95% CI, 0.764-1.268; P = 0.903), hospitalized COVID-19 vs non-hospitalized COVID-19 (OR, 1.233; 95% CI, 0.756-2.012; P = 0.401), hospitalized COVID-19 compared to general population (OR, 0.945; 95% CI, 0.704-1.269; P = 0.708), or severe COVID-19 (OR, 0.726; 95% CI, 0.471-1.121; P =.149).1 In hospitalized and non-hospitalized patients with COVID-19, results showed no difference for OSA susceptibility. Notably, there was also no evidence in the results that genetic susceptibility to OSA would increase the risk of COVID-19, although increased risk of OSA was associated with genetic susceptibility to severe COVID-19.
“According to our results, severe COVID-19 is causally linked to OSA, shedding new light on the mechanisms underlying the relationship between OSA and COVID-19. Importantly, this may have indications for clinicians to pay more attention to monitoring OSA and potential treatment of comorbidity, such as airway management in patients with severe COVID-19, as they are more likely to fail extubation and require prolonged mechanical ventilation,” Gao et al noted.1
A strength of this study is that the MR approach had the ability to show a powerful causal relationship between OSA and COVID-19, as this approach has been previously validated for demonstrating such relationships.2 The MR approach also ensured inference of the 2 diseases in both directions, which avoided any misleading causal effects.3 On the other hand, limitations of the analysis included a biased estimate of causal inference and whether the results can be generalized to other populations of different demographics and sizes. Another limitation is that the results were influenced by low instrument bias. Additionally, the results show a relationship between OSA and COVID-19 over a lifetime effect, although the risk of having OSA might be time-based due to age.
Gao et al noted, “Our MR study did not find that genetic predisposition to OSA traits would alter susceptibility to SARS-CoV-2 infection, COVID-19 hospitalization, or severity. Newly and unexpectedly, genetic susceptibility to confirmed severe respiratory COVID-19 was causally associated with an increased risk of OSA in IVW mode, implying that monitoring for OSA should be intensified in COVID-19 patients. severe respiratory checked.