Pediatric Sleep Apnea Doubles Risk for Flu and COVID-19, Five-Year Study Finds
Children with obstructive sleep apnea face nearly twice the risk of contracting influenza or COVID-19 compared to controls, with increased vulnerability persisting even after adenotonsillectomy, according to a five-year study of over 1 million children.
Children with obstructive sleep apnea (OSA) are nearly twice as likely to contract the flu or COVID-19, according to a study published online Feb. 11 in the Journal of Clinical Sleep Medicine. The analysis included 539,127 children aged 2 to 18 years with incident OSA and matched controls without OSA.
During a five-year follow-up period following OSA diagnosis, influenza was diagnosed in 5.1 percent of children with OSA versus 2.8 percent of controls (risk ratio 1.80), while five-year influenza-free survival was 90.27 versus 93.04 percent, respectively (hazard ratio 1.45). COVID-19 was diagnosed in 2.5 versus 1.0 percent (risk ratio 2.496), with five-year COVID-19-free survival of 95.02 and 97.49 percent, respectively (hazard ratio 1.986). Similar effects were seen across age groups.
OSA was also associated with a higher risk for pneumonia due to influenza or COVID-19. The increased vulnerability persists regardless of age or weight.
Adenotonsillectomy did not reduce infection risk. This finding may reflect two clinical and pathophysiological observations: a significant proportion of children experience residual sleep apnea after the procedure, and OSA-related immune dysregulation could impair the recruitment of an appropriate immune response.
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. The study used the TriNetX global health database to track over 1 million children between the ages of 2 and 18 for five years.
Although absolute risks are low, adenotonsillectomy does not lessen susceptibility, suggesting persistent immune dysregulation and supporting prioritization of seasonal vaccination in children with OSA. Framing OSA as a "risk marker" may help overcome hesitancy during routine pediatric counseling. Similar to other respiratory disorders such as asthma, clinicians should prioritize seasonal influenza vaccination at the time of a sleep apnea diagnosis.