Children and adolescents with obstructive sleep apnea (OSA) were twice as likely to be diagnosed as having influenza or COVID-19 in the five years following diagnosis than those without the condition, according to a large study published in the Journal of Clinical Sleep Medicine.
In the retrospective cohort study, researchers led by a team at The Hebrew University in Jerusalem compared data from 539,127 children ages 2 to 18 years with OSA with data from the same number of children without OSA. Children in both groups were followed up for five years.
Influenza was diagnosed in 5.1% of children with OSA, compared with 2.8% in those without the condition (risk ratio [RR], 1.80), while COVID was diagnosed in 2.5% of the OSA group, versus 1% in the control group (RR, 2.50).
OSA was also associated with a higher risk of severe infection. Children with OSA were over 2.5 times more likely to develop influenza-related pneumonia (RR, 2.69) and had a markedly higher risk of developing COVID pneumonia (RR, 25.96; 95% confidence interval, 16.21 to 41.57).
Another new study (see our coverage yesterday) showed that adults with COVID-19 infections—no matter their severity—are at higher risk of new-onset OSA.
Condition may disrupt antiviral defenses
A disorder that causes breathing pauses during sleep, OSA affects an estimated 1% to 4% of otherwise healthy children and is linked to impaired growth, behavioral and cognitive challenges, and both heart-related and metabolic risks like obesity, diabetes, and high blood pressure.
Because OSA is characterized by chronic upper-airway inflammation and immune changes that may disrupt antiviral defenses, and because insufficient and poor-quality sleep (a hallmark of OSA) may increase susceptibility to infections, OSA’s association with respiratory infections is biologically plausible, the researchers say.
“The dysregulation of innate and adaptive immune milieus in pediatric OSA may explain both the increased susceptibility to viral infection and the more severe symptoms that prompt medical attention,” lead author Alex Gileles-Hillel, MD, of The Hebrew University, said in a university press release.
Further analysis of the data found that adenotonsillectomy (removal of the tonsils and adenoids to treat OSA) did not meaningfully reduce infection risk. Increased flu risk in those who did not have surgery was 4.9%; in those who did, risk was 5.6%. Increased COVID risk was 2.5% in untreated children and 2.6% in those who had surgery.
The authors speculate that surgery did not improve outcomes because OSA-related immune changes may persist after treatment and that those changes affect the body’s response to infection. The “current findings underscore the added importance of vaccinating children diagnosed with OSA against these common viruses,” they write.
A ‘practical flag’ for preventive care
Coauthor Joel Reiter, MD, emphasizes the importance of vaccination, noting in the press release that sleep apnea should be considered a “practical flag” for preventive health care: “Because these children are at a higher risk for both contracting and suffering complications from seasonal viruses, the research supports prioritizing them for annual vaccinations,” he said.
Gileles-Hillel concurs, suggesting that framing OSA as a “risk marker” for increased chances of respiratory infections and severe disease could help overcome vaccine hesitancy.
