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Should People With Sleep Apnea Be Prioritized for the COVID-19 Vaccine?

man sleeping with CPAP machine

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Key Takeaways

  • Despite mounting evidence, obstructive sleep apnea has yet to be listed by the CDC as an underlying medical condition that puts patients at an increased risk of COVID-related hospitalization and death.
  • While some with sleep apnea fall into COVID-19 vaccine priority groups due to coexisting conditions, occupations, and/or age, there are many others hoping their chance at a vaccine will be prioritized accordingly.
  • Patient advocacy organizations and sleep-medicine specialists worry most about those who have the condition and remain undiagnosed and/or properly treated; many are women and minorities.

After falling asleep while driving multiple times and waking up in the middle of the night gasping for breath, Linda Erickson tells Verywell she knew something was wrong. “I’d been a snorer for years, but this was so scary.” In 2008, at age 47, she was diagnosed with sleep apnea and has been using continuous positive airway pressure (CPAP) therapy to treat and manage her condition since. 

“I think CPAP users should be considered as being high risk for COVID-19 and offered the vaccine in the 1c group,” she says.

Ultimately, Erickson, a special education teacher who also has high blood pressure, received her COVID-19 vaccine because of her essential worker status, which is prioritized in phase 1b in Illinois. Her husband, who is also a CPAP user, along with many others with sleep apnea, are still waiting and wondering where they fall in line for the vaccine.

CDC Recommendations for COVID-19 Vaccine Allocation

  • Phase 1a. healthcare personnel and long-term care facility residents
  • Phase 1b. persons 75 years and older and frontline essential workers 
  • Phase 1c. persons 65–74 years old, persons 16–64 years old with high-risk medical conditions, and other essential workers
  • Phase 2. all persons 16 years and older not previously recommended for vaccination

Obstructive sleep apnea (OSA), which can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow, is estimated to affect 22 million Americans. Despite airway interference, it is not currently listed by the Center for Disease Control and Prevention (CDC) as an underlying medical condition that puts patients at an increased risk for severe illness if they contract COVID-19.  

“The fact that heart disease and COPD are listed as high-risk medical conditions by the CDC and sleep apnea is not makes no sense given everything we know thus far,” Adam Amdur, Board Chair of the American Sleep Apnea Association (ASAA), tells Verywell. “The Greek word ‘apnea’ literally means ‘without breath.’” Amdur is also co-investigator of the longitudinal SleepHealth Mobile App Study (SHMAS) and says the pandemic has led to more broken circadian rhythms than his team can put a finger on yet. “We do know 80% of people with sleep apnea are currently untreated and can go 10 to 15 years before even getting an accurate diagnosis,” he says.

An Unrecognized Risk Factor for COVID-19 Complications 

In January 2021, the results of a BMJ study confirmed OSA as an independent risk factor for severe COVID-19 hospitalization. Another study, published in November 2020, found patients with sleep apnea had an increased rate of COVID-related death.

Jody Tate, MD, a board-certified sleep medicine specialist in Oregon, tells Verywell this research highlights the importance of improved efforts to recognize sleep apnea in patients with COVID-19 infection. “Untreated obstructive sleep apnea can also increase risk for stroke, heart attacks, hypertension, dementia, and cardiac arrhythmias,” she says. “These serious diseases also increase a persons’ risk for worse outcomes if they get COVID-19.”

Tate says it's unclear why exactly OSA is a risk factor for worsening outcomes with COVID-19, but she suspects it is potentially due to the baseline level of inflammation people with OSA have in their bodies.

If You’ve Had COVID-19, Consider Replacing Your CPAP Supplies

The American Academy of Sleep Medicine (AASM) recommends sleep apnea patients who have already had COVID-19 consider replacing their CPAP tubing, filters, and/or mask given the lack of data regarding the possibility of reinfection.

What Is a CPAP Machine?

A CPAP machine is designed to use positive airway pressure to keep the airway open during sleep reducing instances of sleep apnea events and snoring while improving respiration. Users wear a face mask and receive pressurized air from a connected hose. It is considered the gold standard treatment for those diagnosed with sleep disorders.

Companies like Aeroflow Healthcare are in-network with Medicare, Medicaid, and most private insurance providers and can work with both your primary and supplemental or secondary insurance to save you unnecessary out-of-pocket fees on CPAP supplies whenever possible. On their website, Aeroflow recommends the following:

  • Every 6 months: Replace headgear, chinstraps, non-disposable filters, and humidifier water chambers.
  • Every 3 months: Replace masks and tubing.
  • Every month: Replace full-face mask cushions
  • Every 2 weeks: Replace cushions, pillows, and disposable filters

Home Sleep Apnea Testing During COVID-19

Tate recommends that people with poor COVID-19 outcomes be evaluated for sleep apnea to help get to the root of their illness. But testing doesn’t need to be reserved for people who’ve already contracted COVID-19. Anyone with signs of OSA should consider getting screened for the condition in order to prevent complications down the line. In fact, the evaluation is something that can be done at home. 

Before the pandemic, sleep studies typically occurred in a lab. However, many sleep centers are now dispensing home sleep apnea test (HSAT) units through mail delivery or using a curbside pickup and return.

A HSAT will calculate the number of sleep apnea events—breathing pauses plus the number of periods of shallow breathing—a person has per hour while sleeping.

  • Mild: 5 to 14 apnea events in an hour
  • Moderate: 15 to 29 apnea events in an hour
  • Severe: 30 or more apnea events in an hour

AASM recommends the diagnosis of OSA, assessment of treatment efficacy, and treatment decisions not be based solely on automatically scored HSAT data, because the raw data must be reviewed and interpreted by a physician who is either board-certified in sleep medicine or overseen by a board-certified sleep medicine physician.

Many sleep specialists, like Tate, are using telehealth to ensure proper set-up of the HSAT, answer patient questions and concerns, and provide follow-up.

Who Is Most At Risk?

“The stereotype for sleep apnea [patients] has been the obese Caucasian man, but the condition does not discriminate,” Amdur says. 

In a December 2020 commentary published in U.S. News and World Report, Alejandra C. Lastra, MD, points out certain populations—including African Americans and Hispanics—are disproportionately affected with OSA. “Women, even if they have classic symptoms like snoring and sleepiness, are often underdiagnosed and less likely to be referred for evaluation and treatment, despite evidence of health-related risks,” Lastra writes.

Right now, Tate says the main question she is getting from her sleep apnea patients is where and when they can get their vaccines. “I like to bring up the vaccine during my patient visits so I can address any concerns that they may have and provide education,” she says. “Most are excited to get it and want to be vaccinated as soon as possible; they realize that this is our way forward.”

What This Means For You

If you or a family member has signs and symptoms of obstructive sleep apnea, talk to your healthcare provider. Most insurance providers, including Medicare and Medicaid, are covering home sleep apnea testing during the pandemic. Not only can treating sleep apnea improve your health, research shows it can decrease your risk of poor COVID-19 outcomes.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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