Children diagnosed with obstructive sleep apnea (OSA) face a significantly elevated risk of contracting influenza and COVID-19, according to a recent study. The research, spanning five years, reveals that children with OSA are nearly twice as likely to be diagnosed with the flu and more than two and a half times as likely to contract COVID-19 compared to their peers without the condition.
The study, published earlier this month, analyzed data from over 1 million children aged 2 to 18 years. Researchers compared 539,127 children with a new diagnosis of OSA to a matched control group without the condition. The findings indicate that influenza was diagnosed in 5.1% of children with OSA versus 2.8% of controls, representing an 80% higher risk. COVID-19 diagnoses occurred in 2.5% of those with OSA compared to 1.0% in the control group, a more than doubling of risk.
OSA and Immune Dysfunction
Obstructive sleep apnea is a condition where breathing repeatedly stops and starts during sleep. While often associated with snoring, it’s linked to a range of health problems, including impaired immune responses. This new research builds on previous investigations suggesting that pediatric OSA may lead to more severe illness from common childhood viruses. However, this study is the first to demonstrate a clear link between OSA and an increased risk of infection itself.
The study authors hypothesize that the increased susceptibility to viral infections in children with OSA is due to persistent immune dysregulation. OSA causes intermittent hypoxia – periods of low oxygen levels – during sleep. This can disrupt the normal functioning of the immune system, making it less effective at fighting off infections. The research suggests that this immune compromise isn’t simply a result of the sleep disruption itself, but a more fundamental alteration in immune function.
Study Details and Findings
The five-year follow-up period allowed researchers to assess the long-term impact of OSA on infection rates. The data showed consistent results across different age groups, indicating that children of all ages with OSA are at increased risk. The study utilized data from TriNetX, a large, real-world data network, providing a robust sample size and enhancing the reliability of the findings.
Researchers calculated risk ratios (RRs) and Kaplan-Meier hazard ratios (HRs) to quantify the increased risk. The risk ratio for influenza in children with OSA was 1.80 (95% CI, 1.765-1.836), while the hazard ratio was 1.45 (95% CI, 1.421-1.479). For COVID-19, the risk ratio was 2.496 (95% CI, 2.418-2.576) and the hazard ratio was 1.986 (95% CI, 1.924-2.050). These statistics demonstrate a statistically significant increase in the likelihood of contracting both viruses in children with OSA.
Adenotonsillectomy and Immune Response
A sub-analysis of the study investigated whether adenotonsillectomy – surgical removal of the adenoids and tonsils – could mitigate the increased risk. Adenotonsillectomy is a common treatment for OSA in children. However, the results showed that the surgery did not reduce the risk of influenza or COVID-19, even in the 96,004 children in each group who underwent the procedure. This suggests that the immune dysregulation associated with OSA persists even after addressing the airway obstruction.
Implications for Public Health
While the absolute risks of contracting influenza or COVID-19 remain relatively low, the study highlights the importance of prioritizing seasonal vaccination in children with OSA. The findings underscore the need for increased awareness among parents and healthcare providers about the potential link between OSA and increased susceptibility to respiratory infections. Further research is needed to fully understand the mechanisms underlying this association and to identify potential interventions to bolster the immune systems of children with OSA.
The study also found a higher risk of pneumonia resulting from influenza or COVID-19 in children with OSA, suggesting that the condition may not only increase the likelihood of infection but also the severity of illness. This finding reinforces the need for proactive management of OSA and prompt medical attention for children who develop respiratory symptoms.
The research team concluded that children with OSA have a significantly higher risk of influenza and COVID-19 diagnoses for up to five years after an OSA diagnosis. The lack of benefit from adenotonsillectomy suggests that the immune dysregulation is ongoing, supporting the recommendation for seasonal vaccination in this vulnerable population. , the study was published in PubMed.
