PEDIATRIC obstructive sleep apnea raised influenza and COVID-19 diagnoses over five years in a U.S. TriNetX large EHR cohort study.
Pediatric Obstructive Sleep Apnea and Viral Infection Risk
Obstructive sleep apnea in children is often discussed in the context of growth, behavior, and cardiometabolic health, but emerging evidence suggests immune consequences may also matter. In a large real world cohort study using TriNetX, investigators assessed whether pediatric obstructive sleep apnea increases the likelihood of receiving subsequent diagnoses of influenza or COVID-19 over a five-year follow-up.
The analysis included children aged 2–18 years with incident obstructive sleep apnea and matched controls without obstructive sleep apnea. Each matched cohort included 539,127 children, with a mean age of 5.6 years. Outcomes were ICD-10 coded influenza and COVID-19 diagnoses recorded during follow-up.
Higher Influenza and COVID-19 Diagnoses Over Five Years
Across five years, influenza was diagnosed more often in children with pediatric obstructive sleep apnea than in matched controls (5.1% versus 2.8%), corresponding to a risk ratio of 1.80. Time to influenza diagnosis also differed, with influenza free survival of 90.27% in the obstructive sleep apnea group versus 93.04% in controls, and a hazard ratio of 1.45.
A similar pattern was observed for COVID-19. Diagnoses occurred in 2.5% of children with pediatric obstructive sleep apnea compared with 1.0% of controls, with a risk ratio of 2.496. COVID-19 free survival was 95.02% versus 97.49%, with a hazard ratio of 1.986. Effects were reported as similar across age groups, supporting a consistent association from early childhood through adolescence.
Adenotonsillectomy Did Not Lower Susceptibility
Because adenotonsillectomy is commonly used in pediatric obstructive sleep apnea, the investigators performed a treatment sub analysis (96,004 per group) to test whether surgery reduced subsequent viral diagnoses. Adenotonsillectomy did not reduce the elevated risk, suggesting that susceptibility may persist beyond airway focused treatment.
In secondary analyses, pediatric obstructive sleep apnea was also associated with a higher risk of pneumonia due to influenza or COVID-19. The authors note that while absolute risks remained low, the findings align with the concept of persistent immune dysregulation following pediatric obstructive sleep apnea diagnosis.
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.
