REM – predominant obstructive sleep apnea in adults with a history of COVID-19 infection: A case-control study, 2026, Calik et al.

[Chandelier]

REM – predominant obstructive sleep apnea in adults with a history of COVID-19 infection: A case-control study

Calik, Ipek; Peker, Yüksel

Highlights​

• This was a case–control study of 304 adults with and without prior COVID-19.
• OSA prevalence was lower but REM-predominant OSA was more frequent after COVID-19.
• COVID-19 history was independently associated with REM-predominant OSA.
• Fatigue was linked to REM-predominant OSA and female sex.
• REM-predominant OSA may underlie symptoms in Long-COVID.

Abstract​

Study objectives​

An association between COVID-19 and obstructive sleep apnea (OSA) has been reported in literature. We aimed to address the occurrence and phenotypes of OSA in adults with a history of COVID-19 infection and its possible association with long-COVID.

Methods​

In this matched case-control study, 152 individuals with a history of COVID-19 and 152 without were evaluated in a sleep laboratory. Groups were matched for age, sex, and body mass index. OSA was defined as an apnea-hypopnea index (AHI) ≥15/h. Rapid Eye Movement (REM)-predominant OSA was defined as AHI ≥15/h and REM-AHI/non-REM-AHI ≥2. Fatigue, reported as “frequent/very frequent,” was used as a surrogate marker of long-COVID.

Results​

The prevalence of OSA was significantly lower in the case group (50.0 %) compared to the control group (77.6 %) (p < 0.001). However, 36 cases (47.4 %) exhibited REM-predominant OSA while 21 controls (17.8 %) demonstrated this phenotype (p < 0.001). In a multiple logistic regression analysis, there was a significant correlation between prior COVID-19 infection and the occurrence of REM-predominant OSA (Odds ratio [OR] 3.14; 95 % confidence interval [CI] 1.89–5.25; p < 0.001). Fatigue was observed in 52.8 % of patients with REM-predominant OSA and 35.7 % of patients without REM-predominant OSA (p = 0.033). In the entire cohort, the factors determining the fatigue were female sex (OR 2.02; 95 % CI 1.12–3.64, p = 0.019) and REM-predominant OSA (OR 2.18; 95 % CI 1.29–3.69; p = 0.004).

Conclusions​

REM-predominant OSA is highly prevalent among individuals with prior COVID-19 infection and is significantly associated with fatigue, underscoring the need to recognize this phenotype in the evaluation and management of Long-COVID.

Graphical abstract​

Web | DOI | Sleep Medicine

 

[Chandelier]

@nataliezzz this might be of interest to you.

 

[Utsikt]

It is not clear from the article how the cases were selected. The control group was matched with the cases based on pre-pandemic clinical records.

The controls had a much higher symptom burden.

The self-reported symptom questionnaire revealed a significantly higher symptom burden in the control group. Snoring (p < 0.001), nocturnal dyspnea (p < 0.001), witnessed apneas (p = 0.005), excessive daytime sleepiness (EDS) (p = 0.002), and difficulty concentrating (p = 0.014) were all reported more frequently in the control group compared to the case group. In addition, an ESS score ≥11 was significantly more common in the control group (p = 0.018) (Table 1).

The controls also had higher AHI scores for all sleep stages and sleep positions.

But they found that having REM-predominant OSA (so relatively more AHI during REM compared to non-REM, was associated with fatigue scores in the cases.

Based on this, they conclude that REM-predominant OSA might cause fatigue.

I don’t see how that logic holds up when the controls had more REM AHI events than the cases - meaning that they should be experiencing more fatigue than the cases if AHI during REM actually causes fatigue.