COVID-19, an infectious disease caused by the SARS-CoV-2 virus, primarily manifests as a respiratory illness, though its symptoms can range from mild to severe. Sleep apnea is a serious sleep disorder where breathing repeatedly pauses or becomes very shallow during sleep. This article explores the observed connections between COVID-19 infection and sleep apnea, examining how the virus might contribute to new diagnoses or worsen existing conditions.
COVID-19 and New-Onset Sleep Apnea
Questions arose early in the pandemic about whether COVID-19 could lead to new-onset sleep apnea. While a definitive causal link to obstructive sleep apnea (OSA) is still being explored, research continues.
A study found that the incidence of new obstructive sleep apnea diagnoses was higher after COVID-19 infection compared to a non-COVID-19 comparison group. The risk increased by 51% at three months and 57% at one year of follow-up in the COVID-19 group. Another study noted a 35% prevalence of newly diagnosed obstructive sleep apnea in patients experiencing lingering COVID-19 symptoms like fatigue or sleepiness. This suggests post-COVID-19 sleepiness, fatigue, and issues with memory or concentration might be linked to reduced sleep efficiency and undiagnosed sleep apnea.
Establishing a direct causal link remains complex due to various contributing factors and ongoing research. Therefore, healthcare providers should consider evaluating for sleep apnea in patients following a COVID-19 infection to help prevent future long-term health concerns.
COVID-19’s Influence on Pre-Existing Sleep Apnea
For individuals already diagnosed with sleep apnea, a COVID-19 infection may exacerbate their condition. Untreated sleep apnea contributes to persistent inflammation, which could trigger a more intense immune response to SARS-CoV-2. Studies indicate that people with pre-existing obstructive sleep apnea might experience more severe COVID-19 symptoms, including a higher likelihood of hospitalization. Patients with pre-existing OSA infected with COVID-19 showed higher inflammatory markers and prolonged ICU stays, indicating sleep apnea can intensify the hyperinflammatory response associated with severe COVID-19 cases.
Both COVID-19 and sleep apnea can lead to lower blood oxygen levels, and when combined, this problem may be compounded. This can intensify inflammation, potentially accelerate viral growth, and increase the risk of damage to organs like the kidneys or cardiovascular system. The general physical toll of severe illness, including deconditioning or weight changes experienced during or after COVID-19, could also worsen existing sleep apnea.
Biological Pathways Connecting COVID-19 and Sleep Apnea
The interaction between COVID-19 and sleep apnea likely involves several biological pathways. Systemic inflammation, a hallmark of severe COVID-19, can affect respiratory control centers in the brain or upper airway tissues. Sleep deprivation, often associated with sleep apnea, itself generates inflammatory cytokines which could worsen the pulmonary inflammatory process seen in COVID-19.
The virus may also have direct neurological effects on the brainstem or autonomic nervous system, which regulate breathing patterns during sleep. Research suggests the virus could impact the brain’s blood supply or directly infect the central nervous system.
Pulmonary issues, such as reduced lung capacity or pulmonary fibrosis, can also contribute to breathing difficulties that predispose individuals to sleep apnea. Scarring from conditions like pulmonary fibrosis reduces lung function, making normal breathing harder and increasing the likelihood of airway collapse during sleep. Oxygen deprivation from sleep apnea can also damage lung tissues, potentially worsening fibrosis.
Addressing Sleep Disturbances After COVID-19
Individuals experiencing new or worsening sleep disturbances after a COVID-19 infection should consult a healthcare professional for proper evaluation and diagnosis. Symptoms such as loud snoring, gasping for air during sleep, or excessive daytime sleepiness warrant medical attention. A healthcare provider may recommend a sleep study, known as polysomnography, which monitors various bodily functions during sleep, including brain activity, heart rate, breathing patterns, and blood oxygen levels.
Establishing a consistent sleep schedule by going to bed and waking up around the same time each day helps reinforce the body’s natural sleep cycle. Creating a relaxing bedtime routine and ensuring the sleep environment is cool, dark, and quiet can promote better rest. Limiting caffeine and alcohol intake, especially before bedtime, also contributes to improved sleep quality. While many post-viral symptoms can improve over time, addressing sleep problems is important for overall recovery and well-being.