Risk of post-acute sequelae of SARS-CoV-2 infection associated with pre-coronavirus disease obstructive sleep apnea diagnoses: an electronic health record-based analysis from the RECOVER initiative.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) has been associated with more severe acute coronavirus disease-2019 (COVID-19) outcomes. We assessed OSA as a potential risk factor for Post-Acute Sequelae of SARS-CoV-2 (PASC). METHODS: We assessed the impact of preexisting OSA on the risk for probable PASC in adults and children using electronic health record data from multiple research networks. Three research networks within the REsearching COVID to Enhance Recovery initiative (PCORnet Adult, PCORnet Pediatric, and the National COVID Cohort Collaborative [N3C]) employed a harmonized analytic approach to examine the risk of probable PASC in COVID-19-positive patients with and without a diagnosis of OSA prior to pandemic onset. Unadjusted odds ratios (ORs) were calculated as well as ORs adjusted for age group, sex, race/ethnicity, hospitalization status, obesity, and preexisting comorbidities. RESULTS: Across networks, the unadjusted OR for probable PASC associated with a preexisting OSA diagnosis in adults and children ranged from 1.41 to 3.93. Adjusted analyses found an attenuated association that remained significant among adults only. Multiple sensitivity analyses with expanded inclusion criteria and covariates yielded results consistent with the primary analysis. CONCLUSIONS: Adults with preexisting OSA were found to have significantly elevated odds of probable PASC. This finding was consistent across data sources, approaches for identifying COVID-19-positive patients, and definitions of PASC. Patients with OSA may be at elevated risk for PASC after SARS-CoV-2 infection and should be monitored for post-acute sequelae.

Tunneling in H loss from energy selected ethanol ions.

The H/D loss and CH(3)/CD(3) loss reactions from energy selected ethanol isotopologue ions C(2)H(5)OH(+), C(2)D(5)OD(+), CD(3)CH(2)OH(+), and CH(3)CD(2)OH(+) have been studied by imaging threshold photoelectron photoion coincidence (iPEPICO) spectroscopy. In the lowest energy dissociation channel, the α-carbon loses a hydrogen or a deuterium atom. Asymmetry in the daughter ion time-of-flight (TOF) peaks, an ab initio study of the reaction rates, and shifts in the phenomenological onsets between isotopologues revealed that H/D loss is slow at its onset. Tunneling through a reverse barrier along the reaction coordinate was found to play a significant role. Modeling the data with an Eckart barrier suggests that H loss from light ethanol ions proceeds via a reverse barrier of 151 meV, which agrees very well with the ab initio result of 155 meV. The higher energy methyl loss channel appears at its thermochemical threshold, but the branching ratios for methyl and H loss as a function of the ion internal energy are not entirely consistent with statistical theory. The methyl-loss signal cannot completely outcompete the hydrogen atom loss process. The shape of the photoelectron spectrum as well as our calculations indicate that the lowest energy ethanol ion structure lies considerably below the reported IE of 10.48 eV. Franck-Condon factors are favorable for ionization to a metastable ion state, which can rearrange to a more stable equilibrium structure. Combining theoretical results with previous experimental ones yields a revised ethanol adiabatic ionization energy of 10.37 eV. This applies to all isotopologues, as the isotope effect on the ionization energy is not more than a few meV.