Children with obstructive sleep apnea (OSA) are about twice as likely to contract influenza or COVID-19 as children without this sleep disorder – regardless of age or weight. This was the finding of a five-year study of over a million children aged 2 to 18 years, published in the Journal of Clinical Sleep Medicine. Even after an adenotonsillectomy (removal of tonsils and adenoids), the increased risk of infection persists.
The research team, led by Dr. Alex Gileles-Hillel and Dr. Joel Reiter from the Hebrew University of Jerusalem and Hadassah Medical Center, along with Dr. David Gozal from Marshall University, utilized the global TriNetX healthcare database. The analysis showed:
- Children with OSA had an 80 percent increased risk of contracting influenza.
- The risk of a COVID-19 diagnosis was approximately 2.5 times higher.
- The risk of pneumonia as a complication of the viruses was also significantly increased.
The authors attribute the increased susceptibility to long-term dysregulation of the innate and adaptive immune systems, caused by the repeated oxygen drops and sleep disturbances in OSA. Dr. Gileles-Hillel emphasized that these immune changes could explain both the increased susceptibility to infection and more severe disease courses that frequently require medical treatment.
Contrary to the expectations of many parents and doctors, surgical removal of the tonsils and adenoids did not significantly reduce the risk of infection. Dr. Gozal explained that this might be because residual apnea persists in a significant proportion of children. Furthermore, OSA-related immune dysfunction may not be fully reversible and may impair the recruitment of an adequate immune response.
The researchers see the diagnosis of obstructive sleep apnea as a practical "risk marker." Children with OSA should therefore be considered for priority annual influenza and COVID-19 vaccinations – similar to asthma or other chronic respiratory diseases. Dr. Reiter highlighted that this classification could help overcome vaccine hesitancy in pediatric consultations.
The study underscores that sleep apnea represents a relevant immunological risk beyond the known symptoms (snoring, daytime sleepiness) and requires consistent prevention of seasonal respiratory infections.
