Pediatric Sleep Apnea Linked to Higher Flu & COVID-19 Risk: 5-Year Study

Children with obstructive sleep apnea (OSA) face a significantly increased risk of contracting influenza and COVID-19, according to a large, five-year study published in the Journal of Clinical Sleep Medicine. The research, utilizing data from over a million children, reveals a heightened susceptibility to these viral infections, even in those who have undergone treatment for OSA.

Increased Risk of Influenza and COVID-19

The study, conducted by researchers at The Hebrew University in Jerusalem and Marshall University, analyzed data from the TriNetX global health database. Researchers compared over 539,000 children aged 2-18 with a new diagnosis of OSA to a matched control group without the condition. The findings demonstrate a clear association between OSA and increased rates of both influenza and COVID-19 diagnoses over the five-year follow-up period.

Specifically, children with OSA were 80% more likely to be diagnosed with influenza compared to their counterparts without OSA. Influenza was diagnosed in 5.1% of children with OSA versus 2.8% of controls. Similarly, the risk of COVID-19 diagnosis was 2.5 times higher in children with OSA (2.5% versus 1.0%). These differences translated to statistically significant hazard ratios, indicating a greater likelihood of contracting these viruses over time.

The study also highlighted the severity of illness. Children with OSA were more than 2.5 times as likely to develop pneumonia related to influenza, and a striking 26 times more likely to develop pneumonia due to COVID-19. While the absolute risk of pneumonia remains relatively low, these findings underscore the potential for more severe outcomes in children with OSA who contract these viral infections.

Immune Dysregulation as a Potential Mechanism

Obstructive sleep apnea is characterized by repeated pauses in breathing during sleep, leading to intermittent hypoxia (low oxygen levels) and sleep fragmentation. Researchers hypothesize that these physiological disturbances may contribute to immune dysregulation, making children with OSA more vulnerable to viral infections. The study authors suggest that OSA may disrupt the body’s antiviral defenses, increasing susceptibility to both infection and more severe illness.

Adenotonsillectomy Does Not Eliminate Risk

Adenotonsillectomy, the surgical removal of the adenoids and tonsils, is a common treatment for OSA in children. However, the study found that undergoing this procedure did not eliminate the increased risk of influenza or COVID-19. A sub-analysis of over 96,000 children in each group who had undergone adenotonsillectomy revealed that the elevated risk persisted, suggesting that the underlying immune dysfunction associated with OSA may not be fully resolved by airway surgery.

This finding is particularly important, as it suggests that even after successful treatment of the anatomical obstruction causing OSA, children may remain at increased risk of viral infections due to long-term changes in their immune systems. This highlights the need for continued vigilance and preventative measures in this population.

Implications for Public Health and Clinical Practice

The study’s findings have significant implications for public health and clinical practice. Given the increased risk of viral infections in children with OSA, the researchers emphasize the importance of consistent seasonal vaccinations, including annual influenza vaccines and updated COVID-19 boosters. They suggest that a diagnosis of OSA should be considered a “risk marker,” prompting healthcare providers to prioritize vaccination efforts in these patients.

While the study demonstrates a strong association between OSA and increased viral infection risk, it’s important to note that it does not prove causation. Further research is needed to fully elucidate the mechanisms underlying this relationship and to identify potential interventions to mitigate the increased risk. However, the current findings provide compelling evidence that OSA is not simply a sleep disorder, but a condition with potentially far-reaching implications for immune function and overall health.

The researchers acknowledge that the study relied on ICD-10 coded diagnoses, which may be subject to variations in clinical practice. However, the large sample size and rigorous methodology strengthen the validity of the findings. The study was published on February 11, 2026.

Reference: Gileles-Hillel A et al. Risk of influenza and COVID-19 illness and pediatric obstructive sleep apnea: a TriNetX cohort with 5-year follow-up. J Clin Sleep Med. 2026;22:31.