Evidence map›Paper›PMID 42029862›Full record

ArticleSleep & breathing = Schlaf & Atmung2026

Obstructive sleep apnea, positive airway pressure therapy, and COVID-19 outcomes.

Matthew Klimper, Jiaxiao Shi, Adam V Benjafield, Kate V Cole, Aiyu Chen, Joanie Chung, Jessica Arguelles, Nathanael H Hwang, Kendra A Becker, Joseph B Kim and 5 more

Abstract read
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In one paragraph

Article in Sleep & breathing = Schlaf & Atmung, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Matthew KlimperSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Jiaxiao ShiDepartment of Research and Evaluation, Kaiser Permanente Southern California, Southern California, USA.
Adam V BenjafieldResMed Science Center, ResMed Corp, San Diego, USA.
Kate V ColeResMed Science Center, ResMed Corp, San Diego, USA.
Aiyu ChenDepartment of Research and Evaluation, Kaiser Permanente Southern California, Southern California, USA.
Joanie ChungDepartment of Research and Evaluation, Kaiser Permanente Southern California, Southern California, USA.
Jessica ArguellesSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Nathanael H HwangSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Kendra A BeckerSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Joseph B KimSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Rosa R WoodrumSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Cecilia PortugalDepartment of Research and Evaluation, Kaiser Permanente Southern California, Southern California, USA.
Olivia H HwangScaled Insights, London, England.
Prasanth ManthenaSleep Medicine, Kaiser Permanente Southern California, Southern California, USA.
Dennis HwangSleep Medicine, Kaiser Permanente Southern California, Southern California, USA. Dennis.X.Hwang@kp.org.ORCID http://orcid.org/0000-0002-4070-1640

Funding

American Academy of Sleep Medicine Foundation 205-SR-19Kaiser Permanente Division of Research KP-RRC-KP-RRC-20190502
6 · The paper itself

Abstract

purposeTo quantify the association between obstructive sleep apnea (OSA) and COVID-19 outcomes and test whether adherence to positive airway pressure (PAP) therapy modifies this relationship.

methodsThis retrospective cohort study compared groups with and without OSA, stratified by degrees of PAP adherence (February 1, 2020 to July 31, 2020) from an integrated healthcare system (Kaiser Permanente Southern California). Rates of COVID-19 infection and hospitalization were compared. Multivariable logistic regression estimated adjusted associations, controlling for demographic and clinical factors.

resultsAmong 78,317 patients analyzed, a pattern revealed increased COVID-19 infection rate in those with OSA and decreased with PAP therapy: No OSA 1.9%; Untreated OSA (PAP use < 2 h/night) 2.2%; Moderately-treated OSA (PAP use 2–3.9 h/night) 1.9%; Well-treated OSA (PAP use ≥ 4 h/night) 1.4% (P < 0.0001). In adjusted models (reference: untreated OSA), odds of infection were lower for patients without OSA (aOR 0.83, 95% CI 0.71–0.97), similar with moderately-treated (2.0–3.9 h/night; aOR 0.88, 95% CI 0.70–1.12), and lower with well-treated OSA (≥ 4 h/night; aOR 0.71, 95% CI 0.62–0.82). Compared with White patients, Black and Hispanic patients had higher odds of infection (aORs 1.46 [1.21–1.77] and 2.14 [1.89–2.43]) and hospitalization (2.02 [1.22–3.35] and 1.66 [1.12–2.46]), highlighting disparities. Neither OSA nor PAP use appeared to influence COVID-19 hospitalization rates, although overall incidences were small.

conclusionsOSA was associated with higher risk of COVID-19 infection, whereas greater PAP adherence was associated with lower risk, suggesting potential pathogenic effects of untreated OSA and protective effects of PAP.

Indexed as

Continuous Positive Airway PressureCOVID-19Sleep Apnea, ObstructiveAdultAgedCaliforniaComorbidityFemaleHospitalizationHumansMaleMiddle AgedPandemicsPatient ComplianceRetrospective StudiesSARS-CoV-2Continuous positive airway pressureCOVID-19EpidemiologyHealthcare disparitiesSleep apnea, obstructive

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.