Obstructive Sleep Apnea as a Risk Factor for COVID-19 Severity—The Gut Microbiome as a Common Player Mediating Systemic Inflammation via Gut Barrier Dysfunction
Saif Mashaqi,
Rekha Kallamadi,
Abhishek Matta,
Stuart F. Quan,
Salma I. Patel,
Daniel Combs,
Lauren Estep,
Joyce Lee-Iannotti,
Charles Smith,
Sairam Parthasarathy,
David Gozal
Affiliations
Saif Mashaqi
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
Rekha Kallamadi
Department of Internal Medicine, The University of North Dakota School of Medicine, Grand Forks, ND 58203, USA
Abhishek Matta
Department of Internal Medicine, The University of North Dakota School of Medicine, Grand Forks, ND 58203, USA
Stuart F. Quan
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
Salma I. Patel
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
Daniel Combs
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
Lauren Estep
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
Joyce Lee-Iannotti
Department of Sleep Medicine, The University of Arizona College of Medicine, Phoenix, AZ 85006, USA
Charles Smith
The Intermountain Healthcare, Merrill Gappmayer Family Medicine Center, Provo, UT 84604, USA
Sairam Parthasarathy
Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, The University of Arizona College of Medicine, Tucson, AZ 85719, USA
David Gozal
Department of Child Health, University of Missouri School of Medicine, Columbia, MO 65201, USA
The novel corona virus that is now known as (SARS-CoV-2) has killed more than six million people worldwide. The disease presentation varies from mild respiratory symptoms to acute respiratory distress syndrome and ultimately death. Several risk factors have been shown to worsen the severity of COVID-19 outcomes (such as age, hypertension, diabetes mellitus, and obesity). Since many of these risk factors are known to be influenced by obstructive sleep apnea, this raises the possibility that OSA might be an independent risk factor for COVID-19 severity. A shift in the gut microbiota has been proposed to contribute to outcomes in both COVID-19 and OSA. To further evaluate the potential triangular interrelationships between these three elements, we conducted a thorough literature review attempting to elucidate these interactions. From this review, it is concluded that OSA may be a risk factor for worse COVID-19 clinical outcomes, and the shifts in gut microbiota associated with both COVID-19 and OSA may mediate processes leading to bacterial translocation via a defective gut barrier which can then foster systemic inflammation. Thus, targeting biomarkers of intestinal tight junction dysfunction in conjunction with restoring gut dysbiosis may provide novel avenues for both risk detection and adjuvant therapy.
