New Study Finds Link Between Severe COVID and Sleep Apnea

by | Last updated Jan 31, 2022

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It’s 2022, and the COVID-19 pandemic seems to show no sign of slowing down anytime soon. While painstaking research continues to reveal more and more about the coronavirus than we originally knew, the findings are not always optimistic.

One recent study has found that sleep disordered breathing— including sleep apnea and sleep related hypoxia— is a major risk factor for severe COVID-19 infection, hospitalization, and even death from the virus. 

This does not mean that your risk of contracting COVID-19 is increased if you have sleep apnea. However, it’s still important to know why this puts you at increased risk if you or a loved one do have sleep apnea or experience sleep disordered breathing.

If you’re already familiar with the disorder and common health risks associated with it, you can skip ahead to our discussion of the recent study and the connection between severe COVID and sleep apnea. Otherwise, we’ll start by briefly discussing the health risks that sleep apnea presents even outside the pandemic.

The Dangers of Sleep Apnea

Sleep apnea is a very serious sleep disorder where you can experience as few as 5 and potentially more than 31 breathing interruptions in a single hour. We’ve written many articles about the dangers and associated health risks sleep apnea presents to your health. A few of these health risks include:

  • Hypertension
  • Erectile dysfunction
  • Diabetes
  • Cardiovascular disease
  • Chronic pain
  • Obesity
  • Sleep deprivation

To make matters worse, sleep apnea can even make treating other health conditions much more difficult. 

Many people with sleep apnea are undiagnosed and unaware they have the condition, which can worsen their health without them realizing it. When this is the case, other health problems (such as diabetes or hypertension) are more difficult to treat unless the sleep apnea is diagnosed and treated.

Unfortunately, the health dangers associated with sleep apnea have increased during the pandemic because it can also increase your risk of developing a more severe form of the coronavirus disease.

COVID-19 and Sleep Apnea

It’s well known that your sleep apnea symptoms can worsen other health conditions like heart disease and diabetes. But new research has found that if you have sleep apnea, you may be at a much greater risk of developing complications from the coronavirus.

New Study Finds Untreated Sleep Apnea Increases Risk of Severe COVID-19 Symptoms 

A study published by JAMA Network Open has found that low oxygen levels during sleep can increase your risk of developing a severe COVID-19 infection, being hospitalized, and even dying from the virus. In particular, sleep disordered breathing, sleep apnea, and sleep related hypoxia, or low oxygen levels during sleep, increase this risk.

This study observed almost 360,000 patients in the Cleveland Clinic system who were tested for COVID-19. 5400 of these patients had also previously completed a sleep study. Of these people, factors like the timing of the sleep study and the use of PAP treatment were also taken into account. 

PAP usage appeared to neither increase nor decrease a patient’s risk of getting the virus. Individuals receiving PAP therapy were largely excluded from the analysis as well, because patients adhering to PAP therapy experienced lesser degrees of hypoxia compared to non-PAP users.

In patients who tested positive for the coronavirus, the reduced baseline oxygen levels they experienced during sleep were associated with a 31 percent higher risk of being hospitalized and even COVID-19 mortality. 

This statistic indicating a 31 percent higher risk also took any of the patients’ pre-existing health conditions into consideration, including heart disease, cancer, obesity, and lung disease.

While researchers aren’t sure why sleep disordered breathing increases the risk of more severe infections and COVID-19 hospitalization, they do think that inflammation caused by reduced oxygen levels may be a main contributing factor. 

Hypoxia, or low oxygen levels in the body, will increase inflammation and promote the growth and reproduction of viruses in your body. It can also promote elevated inflammatory markers like increased white blood cell and neutrophil counts, in turn amplifying the disease and making the infection more severe.

Sleep apnea does not make you more likely to become infected with the COVID-19 virus. However, sleep apnea can increase the severity of COVID-19 illness if you become infected with the virus. 

CPAP Therapy and COVID-19

CPAP, or continuous positive airway pressure, is the most popular and effective sleep apnea treatment available. 

CPAP therapy treats sleep apnea by gently opening your airways with a gentle, continuous stream of air that allows you to breathe freely and easily while you sleep. This is done via a CPAP machine that generates the constant stream of pressurized air, which is delivered through a specialized headpiece that covers your nose, mouth, or both.

While the study above generally excluded those using CPAP therapy from their findings, it’s worth noting that those results can pave the way for further studies investigating whether early, effective PAP or oxygen treatments can improve COVID-19 outcomes. 

One study seems to support this. This study, published by the European Clinical Respiratory Journal, found that CPAP treatment appears to have a positive effect on oxygenation and respiratory rate in most patients experiencing severe respiratory failure due to COVID-19.

However, it’s crucial to keep your CPAP machines clean and disinfected after you use them. Not only can regular maintenance keep them in working order, but it can help reduce the spread of pathogens that can make you or someone else sick. 

If you or someone you know has been exposed to the coronavirus, it’s important to make sure your CPAP machine can’t continue to spread the virus by sending viral particles into the air where you or others can potentially breathe them in, or through moisture droplets from the machine. This is especially important if they are asymptomatic, or not showing any symptoms of COVID-19.

Related: CPAP Setup, Maintenance and Cleaning

There are steps you can take to prevent untreated sleep disordered breathing (aka obstructive sleep apnea) from worsening your health though.

The Importance of Sleep Apnea Treatment

Sleep apnea will not clear up on its own— it must be appropriately treated to improve your symptoms. The severity of sleep apnea can be reduced— or in milder forms, even eliminated— with positive lifestyle choices, including:

  • Regular moderate exercise
  • Consuming a balanced diet high in whole grains, fresh fruits and vegetables, protein, and healthy fats
  • Losing excess weight
  • Cutting back on alcohol, and quitting smoking
  • Avoiding medications that can contribute to breathing interruptions, such as opioids, benzodiazepines, and muscle relaxants

Remember, sleep apnea and sleep disordered breathing won’t increase your risk of COVID-19 infection, but it can make you more likely to develop a more severe form of the virus. This is another reason why it’s so important to get tested for sleep apnea if you think you may be at risk.

Some sleep apnea symptoms that you and your sleep partner should be aware of include:

  • Loud snoring that can be heard throughout the home
  • Pauses in breathing while you sleep
  • Feeling exhausted and sleep deprived, even after a full night of sleep
  • Aches and body pain, including morning headaches
  • Dry or sore throat in the mornings

If you think you may be at risk of sleep apnea, but aren’t sure, take our sleep apnea quiz. It won’t diagnose you with the disorder, but it will help you understand your symptoms so you can better discuss them with your doctor or a sleep specialist. 

After you understand your symptoms, we recommend you schedule an evaluation with an accredited sleep center near you so you can get the treatment you need.

Don’t let sleep apnea put your health at risk. Contact us at the Sleep Centers of Middle Tennessee to treat your sleep apnea and get the healthy rest you need.


Cinthya Pena Orbea, MD. “Association of Sleep-Related Hypoxia with Covid-19 Outcomes.” JAMA Network Open, JAMA Network, 10 Nov. 2021, LM;Nielsen Jeschke K;Kristensen MT;Krogh-Madsen R;Monefeldt Albek C;Hansen EF; “Covid-19 and Acute Respiratory Failure Treated with CPAP.” European Clinical Respiratory Journal, U.S. National Library of Medicine,

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