Children with obstructive sleep apnea may face a significantly higher risk of contracting influenza and COVID-19, according to a latest study published this month. Researchers found a clear link between the common childhood sleep disorder and increased diagnoses of both respiratory illnesses over a five-year period, raising concerns about the broader immune consequences of pediatric obstructive sleep apnea.
The study, published February 11, 2026, in the Journal of Clinical Sleep Medicine, analyzed data from a large cohort of over one million children using the TriNetX database, a network of electronic health records. Researchers compared 539,127 children aged 2-18 with a diagnosis of obstructive sleep apnea to a matched control group without the condition. The findings suggest that immune system disruption caused by OSA may abandon children more vulnerable to viral infections.
Increased Risk of Influenza and COVID-19
Over the five-year follow-up period, children with obstructive sleep apnea were diagnosed with influenza at a rate of 5.1%, compared to 2.8% in the control group. This translates to a risk ratio of 1.80, indicating an 80% higher likelihood of influenza diagnosis in children with OSA. The study also showed a reduced time to influenza diagnosis, with a five-year influenza-free survival rate of 90.27% in the OSA group versus 93.04% in the control group.
The association was even stronger for COVID-19. Children with OSA had a 2.5% diagnosis rate, compared to 1.0% in the control group, representing a risk ratio of 2.496 – more than double the risk. Five-year COVID-19-free survival was 95.02% in the OSA group and 97.49% in the control group. Importantly, the researchers found these effects were consistent across different age groups, from early childhood through adolescence.
Adenotonsillectomy Doesn’t Appear to Offer Protection
Obstructive sleep apnea in children is often treated with adenotonsillectomy, a surgical procedure to remove the adenoids and tonsils. Still, the study found that this common treatment did not reduce the increased risk of viral infections. Analyzing a subgroup of 96,004 children in each group who underwent adenotonsillectomy, researchers found the surgery did not lessen susceptibility to influenza or COVID-19. This suggests that the immune dysregulation associated with OSA may persist even after addressing airway obstruction.
Researchers also noted a higher risk of pneumonia linked to both influenza and COVID-19 in children with OSA, further highlighting the potential for more severe respiratory complications. Although the absolute risks of infection remain relatively low, the findings underscore the importance of considering the broader health implications of OSA beyond daytime sleepiness and behavioral issues.
Understanding the Link Between Sleep and Immunity
Obstructive sleep apnea is characterized by repeated pauses in breathing during sleep, leading to disrupted sleep and reduced oxygen levels. This disruption can trigger inflammation and stress hormones, potentially weakening the immune system’s ability to fight off infections. “The findings align with the concept of persistent immune dysregulation following pediatric obstructive sleep apnea diagnosis,” the study authors wrote. This means that OSA may not just be a consequence of anatomical factors, but also a condition that actively alters immune function.
The study’s findings have implications for preventative care. While more research is needed to fully understand the mechanisms at play, the authors suggest prioritizing seasonal vaccination in children diagnosed with OSA. Given that adenotonsillectomy doesn’t appear to fully restore immune function, a proactive approach to infection prevention may be particularly vital for this vulnerable population.
The research team emphasizes that these findings do not mean all children with OSA will get sick more often, but rather that they face an elevated risk. Parents and healthcare providers should be aware of this association and consider it when making decisions about preventative care and monitoring for respiratory illnesses.
Further research is planned to investigate the specific immune pathways affected by OSA and to explore potential interventions to bolster immune function in children with the condition. The next step, according to the study, will be to examine the long-term effects of OSA on immune responses and to assess the effectiveness of different treatment strategies in mitigating these risks.
Have thoughts on this story? Share your comments below and connect with us on social media.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
