CHEST Guidelines-Does-Endothelial-Vulnerability-in-OSA-Syndrome-Pro

Does-Endothelial-Vulnerability-in-OSA-Syndrome-Pro

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This commentary explores the potential link between obstructive sleep apnea syndrome (OSAS) and COVID-19 encephalopathy, specifically whether OSAS increases vulnerability to endothelial damage caused by COVID-19. COVID-19 is known to cause extrapulmonary manifestations, including severe neurologic complications like acute encephalopathy. The pathophysiology behind COVID-19 encephalopathy is not completely understood, but systemic and cerebral endothelial inflammation (endotheliitis) has been suggested. OSAS shares many risk factors with severe COVID-19, such as older age, cardiovascular diseases, and obesity. <br /><br />The authors report an observation from Geneva University Hospitals where brain MRIs of patients with COVID-19 encephalopathy often showed signs of endotheliitis. There is a noted increase in cerebrospinal fluid/plasma albumin ratio, suggesting blood-brain barrier dysfunction. OSAS has been linked to endothelial dysfunction through intermittent hypoxia, promoting a proinflammatory and prothrombotic state that could exacerbate this condition when coupled with COVID-19.<br /><br />The paper hypothesizes that the chronic inflammation and endothelial injury inherent in OSAS might heighten the risk of COVID-19 encephalopathy, as these conditions share common traits and trigger inflammatory responses. It particularly notes the "cytokine storm" during severe COVID-19, which leads to widespread endothelial damage. If OSAS contributes to blood vessel fragility, it might, in combination with COVID-19-induced inflammation, lead to more severe neurologic outcomes.<br /><br />The piece concludes that despite the current underdiagnosis of OSAS, understanding its potential exacerbation effects on COVID-19 encephalopathy could inform future clinical practices. Therefore, OSAS could be a significant and manageable risk factor for COVID-19 encephalopathy, warranting further research into their connection.

Keywords

obstructive sleep apnea syndrome

COVID-19 encephalopathy

endothelial damage

endotheliitis

neurologic complications

blood-brain barrier dysfunction

chronic inflammation

cytokine storm

intermittent hypoxia

risk factors