Children with sleep apnea face higher risk of flu and COVID-19, new study finds

A new study led by Dr. Alex Gileles-Hillel along with Dr. Joel Reiter from the Faculty of Medicine at the Hebrew University and senior pediatric pulmonologists at the Hadassah Medical Center, together with Dr. David Gozal from Marshall University, has uncovered a significant link between pediatric obstructive sleep apnea (OSA) and a heightened susceptibility to viral infections. The research, published in the Journal of Clinical Sleep Medicine, the official publication of the American Academy of Sleep Medicine, suggests that children with this common sleep disorder are roughly twice as likely to be diagnosed with influenza or COVID-19 compared to normally sleeping children.

The Connection Between Sleep and Immunity

While sleep apnea is well known for causing snoring and daytime fatigue, researchers have long suspected it also impacts the immune system. This study used the TriNetX global health database to track over 1 million children between the ages of 2 and 18 for five years.

The findings were striking:

• Influenza Risk: Children with sleep apnea had an 80% higher risk of contracting the flu compared to those without the condition.

• COVID-19 Risk: The risk for COVID-19 was even higher, with children with OSA being about 2.5 times more likely to be diagnosed.

• Severe Illness: Sleep apnea was also linked to a much higher risk of developing pneumonia as a complication of these viruses

The researchers believe this vulnerability stems from immune dysregulation. Dr. Alex Gileles-Hillel noted that "the dysregulation of innate and adaptive immune milieus in pediatric OSA may explain both the increased susceptibility to viral infection and the more severe symptoms that prompt medical attention".

Why Surgery Might Not Be Enough

Many parents opt for an adenotonsillectomy (the removal of tonsils and adenoids) to treat their child's sleep apnea. However, the study found that this surgery did not significantly lower the risk of infection.

Dr. David Gozal explained that this finding "may reflect two clinical and pathophysiological observations." First, a significant proportion of children experience residual sleep apnea after the procedure. Second, he noted that "OSA-related immune dysregulation could impair the recruitment of an appropriate immune response. We are actively working on understanding this immune-related susceptibility."

A Risk Marker for Preventive Care

Dr. Joel Reiter emphasized that sleep apnea should be viewed as a practical flag for preventive health. Because these children are at a higher risk for both contracting and suffering complications from seasonal viruses, the research supports prioritizing them for annual vaccinations.

Dr. Alex Gileles-Hillel adds: "framing OSA as a 'risk marker' may help overcome hesitancy during routine pediatric counseling". Similar to other respiratory disorders (e.g., asthma), clinicians should prioritize seasonal influenza vaccination at the time of a sleep apnea diagnosis.

Reference:

Gileles-Hillel, A., Reiter, J. & Gozal, D. Risk of influenza and COVID-19 illness and pediatric obstructive sleep apnea: a TriNetX cohort with 5-year follow-up. J Clin Sleep Med 22, 31 (2026). https://doi.org/10.1007/s44470-025-00035-x