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Respir Med
. 2026 Feb 24:254:108733.
doi: 10.1016/j.rmed.2026.108733. Online ahead of print.
The impact of positive airway pressure (PAP) on severe Coronavirus Disease (COVID-19) among the patients with obstructive sleep apnea (OSA)
Khodadad Namiranian 1 , Lue-Yen Tucker 2 , Bruce F Folck 2
Affiliations
Background: Obstructive sleep apnea (OSA) has been proposed as a risk factor for severe Coronavirus Disease (COVID-19). We hypothesized that treating OSA with positive airway pressure (PAP) decreases the risk of severe COVID-19. To answer this question, the risk of severe COVID-19 was compared between PAP adherent and PAP non-adherent OSA patients.
Methods: This is a retrospective cohort study of patients aged 18-89 with OSA and available data on PAP use who tested positive for SARV-COV-2 before 12/14/2020. The patients were divided into PAP adherent and PAP non-adherent groups based on their PAP use as recorded by the machine. Outcome is "severe COVID-19" (death, ICU admission, intubation, and/or acute respiratory failure) within 3 months of a first positive SARS-COV-2 test. Unadjusted and adjusted logistic regression analyses were performed to assess the association of PAP adherence with the outcome.
Results: Of 256,163 patients with PAP adherence data (37.5% adherent), we found 13,533 with a positive SARS-COV-2 test (32.5% adherent), of which 1666 patients met the inclusion criteria. One-third of these patients were PAP adherent (n = 556, 33.4%). Severe COVID-19 occurred in 13 (2.3%) of adherent and 23 (2.1%) of non-adherent patients. Further analysis did not show any significant association of PAP adherence with severe COVID-19 when unadjusted (OR 1.21, 95%CI 0.88-1.66, p = 0.25) or when adjusting for demographics, selected comorbidities, and OSA severity (OR 0.88, 95%CI 0.43-1.81; p = 0.74).
Conclusion: In this retrospective analysis, the risk of severe COVID-19 was not different between PAP adherent and non-adherent OSA patients.
Keywords: Obstructive sleep apnea (OSA); Positive airway pressure (PAP); Severe Coronavirus Disease (COVID-19); Treatment adherence.
. 2026 Feb 24:254:108733.
doi: 10.1016/j.rmed.2026.108733. Online ahead of print.
The impact of positive airway pressure (PAP) on severe Coronavirus Disease (COVID-19) among the patients with obstructive sleep apnea (OSA)
Khodadad Namiranian 1 , Lue-Yen Tucker 2 , Bruce F Folck 2
Affiliations
- PMID: 41747911
- DOI: 10.1016/j.rmed.2026.108733
Background: Obstructive sleep apnea (OSA) has been proposed as a risk factor for severe Coronavirus Disease (COVID-19). We hypothesized that treating OSA with positive airway pressure (PAP) decreases the risk of severe COVID-19. To answer this question, the risk of severe COVID-19 was compared between PAP adherent and PAP non-adherent OSA patients.
Methods: This is a retrospective cohort study of patients aged 18-89 with OSA and available data on PAP use who tested positive for SARV-COV-2 before 12/14/2020. The patients were divided into PAP adherent and PAP non-adherent groups based on their PAP use as recorded by the machine. Outcome is "severe COVID-19" (death, ICU admission, intubation, and/or acute respiratory failure) within 3 months of a first positive SARS-COV-2 test. Unadjusted and adjusted logistic regression analyses were performed to assess the association of PAP adherence with the outcome.
Results: Of 256,163 patients with PAP adherence data (37.5% adherent), we found 13,533 with a positive SARS-COV-2 test (32.5% adherent), of which 1666 patients met the inclusion criteria. One-third of these patients were PAP adherent (n = 556, 33.4%). Severe COVID-19 occurred in 13 (2.3%) of adherent and 23 (2.1%) of non-adherent patients. Further analysis did not show any significant association of PAP adherence with severe COVID-19 when unadjusted (OR 1.21, 95%CI 0.88-1.66, p = 0.25) or when adjusting for demographics, selected comorbidities, and OSA severity (OR 0.88, 95%CI 0.43-1.81; p = 0.74).
Conclusion: In this retrospective analysis, the risk of severe COVID-19 was not different between PAP adherent and non-adherent OSA patients.
Keywords: Obstructive sleep apnea (OSA); Positive airway pressure (PAP); Severe Coronavirus Disease (COVID-19); Treatment adherence.