Reply to Hu et al. Significant association of obstructive sleep apnoea with increased risk for fatal COVID-19

We thank Hu et al (see Hu M et al [1]) for referring to our publication, in which we systematically examine the available evidence up until 2nd June 2020 of the relationship between obstructive sleep apnoea (OSA) and adverse COVID-19 outcomes [2]. We examined potential causal mechanisms and what effect COVID-19 has had on OSA diagnosis, treatment, and management. It is clear from our review that the pandemic had a detrimental effect on the treatment, management, and diagnosis of OSA worldwide. There were plausible mechanisms by which OSA may independently increase one's risk of morbidity and mortality associated with COVID-19 but, whilst up to June 2020 there were limited studies available, there was some evidence from the CORONADO study to suggest that individuals with diabetes who were also OSA-treated patients may be at increased risk of death from COVID-19. We concluded that it may be necessary to explore new diagnosis and treatment pathways for these individuals and that further research was required to determine whether COVID-19 presented an increased risk for individuals with OSA