Citation:
Salles C, Mascarenhas Barbosa H. COVID-19 and obstructive sleep apnea. J Clin Sleep Med. 2020;16(9):1647.
The authors congratulate McSharry and Malhotra on the publication “Potential influences of obstructive sleep apnea and obesity on COVID-19 severity”1 and, at the same time, pose the following question: How much sleep deprivation from obstructive sleep apnea would be an aggravating factor for the pulmonary inflammatory process in COVID-19? Sleep deprivation is reported to generate a production of inflammatory cytokines such as interleukin-6 and -17, in addition to tumor necrosis factor α, with marked neutrophilia.2,3 In the experimental study conducted by Nunes et al,4 allergic mice under sleep deprivation when using dexamethasone showed greater resistance to the anti-inflammatory effects of corticosteroids, failing to modulate interleukin-17 and tumor necrosis factor α production compared with mice without sleep deprivation. It was also observed that the allergic mice, when exposed to sleep deprivation, showed worsening of the pulmonary inflammatory process. Along these lines, sleep deprivation occurs both in asthma and obstructive sleep apnea, which can potentiate the pulmonary inflammatory process. Furthermore, Teodorescu et al5 observed that patients with asthma who used low doses of inhaled corticosteroids had an odds ratio of 2.29 to develop obstructive sleep apnea; those patients who used moderate doses increased the odds ratio to 3.67; and patients who used high doses had an odds ratio of 5.43. Therefore, obstructive sleep apnea and sleep deprivation could add to the severity of the pulmonary inflammatory process of COVID-19.
Finally, the authors congratulate McSharry and Malhotra for the study and are respectful of the considerations exposed regarding COVID-19 and obstructive sleep apnea.
DISCLOSURE STATEMENT
All authors have seen and approved the manuscript. The authors report no conflicts of interest
REFERENCES
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