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Sleep Apnea Pathophysiology in Patients with a History of COVID-19

Celik, Yeliz ; Sands, Scott A. ; Alex, Raichel ; Peker, Yüksel LU and Redline, Susan (2026) In Journal of Clinical Medicine 15(2).
Abstract

Background: Emerging evidence suggests that COVID-19 may influence obstructive sleep apnea (OSA) pathophysiology by affecting upper airway collapsibility, ventilatory control, and arousal responses, raising the possibility of a bidirectional relationship. This study examined whether individuals with a history of COVID-19 show altered OSA-related physiological traits compared with those without prior infection. Methods: In a case–control study, 60 participants with a history of COVID-19 were compared to 60 matched controls who underwent overnight in-hospital polysomnography before the pandemic. The matching criteria included age (±5 years), gender, body mass index (BMI) (±5 kg/m2), and OSA presence. Key pathophysiological... (More)

Background: Emerging evidence suggests that COVID-19 may influence obstructive sleep apnea (OSA) pathophysiology by affecting upper airway collapsibility, ventilatory control, and arousal responses, raising the possibility of a bidirectional relationship. This study examined whether individuals with a history of COVID-19 show altered OSA-related physiological traits compared with those without prior infection. Methods: In a case–control study, 60 participants with a history of COVID-19 were compared to 60 matched controls who underwent overnight in-hospital polysomnography before the pandemic. The matching criteria included age (±5 years), gender, body mass index (BMI) (±5 kg/m2), and OSA presence. Key pathophysiological traits (collapsibility, loop gain, arousal threshold, muscle compensation) estimated from polysomnographic signals were compared, with adjustment for age, sex, BMI, and apnea–hypopnea index. Results: The participants (78% male, mean age 55 ± 12 years, BMI 29.4 ± 5.0 kg/m2) exhibited no meaningful differences in their average levels of collapsibility (Adj dif [95% CI]; Vpassive: −1 [−4, 2] %eupnea, p = 0.7), loop gain (LG1: 0.01 [−0.04, 0.06], p = 0.7), or arousal threshold levels (−1 [−7, 4] %eupnea) and showed similar levels of muscle compensation (Vcomp: 5 [−1, 11], p = 0.12). However, a greater ventilatory response to arousal (7 [1, 12] %eupnea) was associated with COVID-19 history. Conclusions: COVID-19 history is not associated with differences in key OSA pathophysiological traits, suggesting it is unlikely to explain observed differences in OSA presentation. The increased ventilatory response to arousal may have implications for treatment responses and outcomes.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
arousal threshold, COVID-19, loop gain, obstructive sleep apnea, physiological traits, upper airway collapsibility
in
Journal of Clinical Medicine
volume
15
issue
2
article number
580
publisher
MDPI AG
external identifiers
  • scopus:105028919772
  • pmid:41598517
ISSN
2077-0383
DOI
10.3390/jcm15020580
language
English
LU publication?
yes
id
abcf455e-f380-4b31-ac41-14e45fc527ab
date added to LUP
2026-02-23 15:41:52
date last changed
2026-03-23 22:59:56
@article{abcf455e-f380-4b31-ac41-14e45fc527ab,
  abstract     = {{<p>Background: Emerging evidence suggests that COVID-19 may influence obstructive sleep apnea (OSA) pathophysiology by affecting upper airway collapsibility, ventilatory control, and arousal responses, raising the possibility of a bidirectional relationship. This study examined whether individuals with a history of COVID-19 show altered OSA-related physiological traits compared with those without prior infection. Methods: In a case–control study, 60 participants with a history of COVID-19 were compared to 60 matched controls who underwent overnight in-hospital polysomnography before the pandemic. The matching criteria included age (±5 years), gender, body mass index (BMI) (±5 kg/m<sup>2</sup>), and OSA presence. Key pathophysiological traits (collapsibility, loop gain, arousal threshold, muscle compensation) estimated from polysomnographic signals were compared, with adjustment for age, sex, BMI, and apnea–hypopnea index. Results: The participants (78% male, mean age 55 ± 12 years, BMI 29.4 ± 5.0 kg/m<sup>2</sup>) exhibited no meaningful differences in their average levels of collapsibility (Adj dif [95% CI]; V<sub>passive</sub>: −1 [−4, 2] %<sub>eupnea</sub>, p = 0.7), loop gain (LG<sub>1</sub>: 0.01 [−0.04, 0.06], p = 0.7), or arousal threshold levels (−1 [−7, 4] %<sub>eupnea</sub>) and showed similar levels of muscle compensation (V<sub>comp</sub>: 5 [−1, 11], p = 0.12). However, a greater ventilatory response to arousal (7 [1, 12] %<sub>eupnea</sub>) was associated with COVID-19 history. Conclusions: COVID-19 history is not associated with differences in key OSA pathophysiological traits, suggesting it is unlikely to explain observed differences in OSA presentation. The increased ventilatory response to arousal may have implications for treatment responses and outcomes.</p>}},
  author       = {{Celik, Yeliz and Sands, Scott A. and Alex, Raichel and Peker, Yüksel and Redline, Susan}},
  issn         = {{2077-0383}},
  keywords     = {{arousal threshold; COVID-19; loop gain; obstructive sleep apnea; physiological traits; upper airway collapsibility}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{Sleep Apnea Pathophysiology in Patients with a History of COVID-19}},
  url          = {{http://dx.doi.org/10.3390/jcm15020580}},
  doi          = {{10.3390/jcm15020580}},
  volume       = {{15}},
  year         = {{2026}},
}