Children With Sleep Apnea Face Higher Risk of Flu and COVID-19

Obstructive sleep apnea (OSA) is a condition where a child’s breathing repeatedly stops and starts during sleep. It’s often caused by enlarged tonsils or adenoids. Beyond snoring and restless sleep, researchers have increasingly wondered whether OSA may also affect the immune system.

OSA affects about 1% to 4% of otherwise healthy children and has been linked to slower physical growth, behavior and learning challenges, and higher risks for heart and metabolic issues.

At the same time, seasonal flu has long been one of the most common causes of respiratory illness in children. Flu activity changes from year to year depending on the strain and how widely it spreads. More recently, COVID-19 has added to the overall burden of respiratory infections in kids.

Because sleep apnea can affect the body in many ways, including potentially the immune system, it makes sense that children with sleep-disordered breathing might respond differently to viral infections like the flu or COVID-19. However, until recently, there has been limited research specifically looking at how these infections affect children with OSA.

In a large study published in the Journal of Clinical Sleep Medicine, a team of investigators examined this link, and whether removing the tonsils and adenoids (adenotonsillectomy) lowers that risk.

Using a massive health database, the team compared more than 539,000 children between the ages of 2 to 18 years with newly diagnosed OSA to the same number of children without OSA. The children’s health was followed for five years.

What did they find?

Over five years, the following occurred:

• Flu (influenza) was diagnosed in:
  • 5.1% of children with OSA
  • 2.8% of children without OSA
    Children with OSA were about 80% more likely to be diagnosed with the flu.
• COVID-19 was diagnosed in:
  • 2.5% of children with OSA
  • 1.0% of children without OSA
    Children with OSA were about 2.5 times more likely to be diagnosed with COVID-19.

These increased risks were seen across all age groups (ages 2 to 18).

Investigators also found that children with OSA had a higher risk of developing pneumonia related to flu or COVID-19.

“In the era of vaccine hesitancy and parental concern about risks versus benefits of seasonal influenza vaccination, our findings should reinforce clinicians in their quest to encourage families of children with OSA to pursue vaccination,” wrote investigators. “Given the 2-fold elevation in risk, OSA could be viewed as a practical flag for preventive care.”

Did surgery help?

Many children with OSA undergo adenotonsillectomy. However, in a subgroup analysis of nearly 100,000 children per group, surgery did not reduce the risk of flu or COVID-19.

What does this mean for families?

The overall risk of infection was still relatively low. But compared with children without OSA, those with OSA had a significantly higher chance of being diagnosed with viral respiratory infections over the next five years.

Investigators suggest this may reflect ongoing immune system changes related to OSA, even after surgical treatment.

“While the absolute risk is relatively low, this increased susceptibility is not reduced by adenotonsillectomy alone and may reflect persistent immune dysregulation in this population,” concluded investigators.