Children with obstructive sleep apnea are diagnosed with influenza and COVID-19 at significantly higher rates than their peers, according to a new study published in the Journal of Clinical Sleep Medicine. The research, which tracked nearly 1.1 million children over five years, reveals a heightened susceptibility to viral respiratory illnesses in those with the sleep disorder.
Investigators analyzed data from a large U.S. Cohort using the TriNetX electronic health record database, comparing 539,127 children aged 2–18 with a diagnosis of obstructive sleep apnea to a matched control group without the condition. The study found that children with sleep apnea were nearly twice as likely to be diagnosed with influenza (5.1% versus 2.8%) and more than 2.4 times as likely to be diagnosed with COVID-19 (2.5% versus 1.0%).
The increased risk wasn’t limited to diagnosis rates. the time to diagnosis was also affected. Children with obstructive sleep apnea experienced a 45% increased hazard ratio for influenza diagnosis and a 99% increased hazard ratio for COVID-19 diagnosis compared to controls. Influenza-free survival was 90.27% in the sleep apnea group, compared to 93.04% in the control group. COVID-19 free survival was 95.02% versus 97.49% respectively.
The study also examined the impact of adenotonsillectomy, a common surgical treatment for pediatric obstructive sleep apnea. Researchers found that undergoing the procedure did not mitigate the increased risk of viral infection, suggesting that the underlying immune dysregulation associated with sleep apnea persists even after airway obstruction is addressed. A sub-analysis of 96,004 children per group showed no reduction in viral diagnoses following adenotonsillectomy.
Researchers also observed a correlation between pediatric obstructive sleep apnea and a higher risk of pneumonia resulting from influenza or COVID-19, further supporting the link between the sleep disorder and respiratory complications. While the absolute risks of these infections remain relatively low, the findings suggest a consistent pattern of immune vulnerability across different age groups, from early childhood through adolescence.
The study authors note that the findings align with a growing understanding of the immune consequences of obstructive sleep apnea, which extends beyond its well-established effects on growth, behavior, and cardiometabolic health. The research highlights the potential for persistent immune dysregulation following a diagnosis of pediatric obstructive sleep apnea.
