Influences of sleep and lifestyle factors on the risk for covid-19 infections, from internet survey of 10,000 Japanese business workers

We conducted an internet survey to assess sociodemographic variables, lifestyle factors, sleep problems, and comorbidities for sleep apnea syndrome (SAS) in COVID-19 and influenza (FLU) infections. Data from 10,323 workers (50.0% male) were analyzed. COVID-19 was diagnosed in 144 subjects (COVID-19+), and 8,693 were classified as not suspected to be infected (COVID-19−). SAS had been diagnosed in 35.4% of the COVID-19+ subjects, but only 231 (2.7%) of the 8,693 COVID-19− subjects. COVID-19+ subjects were more susceptible to FLU (35.4%) compared to COVID-19− subjects (3.0%). A multivariate analysis revealed that higher risks of COVID-19+ were linked to the following factors: going out without a face mask (OR 7.05, 95% CI 4.53–11.00), FLU+ (OR 6.33, 95% CI 3.80–10.54), excessive exercise before going to sleep (OR 2.10, 95% CI 1.63–2.70), SAS+ (OR 5.08, 95% CI 2.88–8.94), younger age (OR 1.05, 95% CI 1.03–1.07), falling sleep while sitting or talking with someone (OR 3.70, 95% CI 2.30–5.95), and use of hypnotics (OR 2.28, 95% CI 1.20–4.30). Since sleep impairment played a relatively small role in COVID-19+/SAS− subjects, we assume that SAS itself was a more significant risk factor for COVID-19 infection rather than sleep impairment. A better understanding of the mechanisms that result in increased susceptibility to COVID-19 in SAS is vital for helping prevent COVID-19.