18 Feb Sleep Apnea in Kids Associated with Increased Risk of COVID and Flu
MedicalResearch.com Interview with:
Dr. Gileles-Hillel
Dr. Alex Gileles-Hillel MD
Founder and director of Gileles Lab
Hadassah Medical Center
Along with Dr. Joel Reiter MD from the Faculty of Medicine
Hebrew University and Senior Pediatric Pulmonologists at the Hadassah Medical Center
with Dr. David Gozal MD, MBA, PhD from Marshall University
MedicalResearch.com: What is the background for this study?
Response: Children with Obstructive Sleep Apnea (OSA) experience increased morbidity, including cognitive difficulties, daytime dysfunction, and poorer academic performance, as well as a higher risk of future cardiometabolic disease such as hypertension and obesity. In addition, pediatric OSA has been shown to impair immune responses and alter immunologic function, although the clinical consequences of these changes remain incompletely understood.
MedicalResearch.com: What are the main findings?
Response: Against this background, we analyzed a cohort of over one million children with and without OSA. After accounting for key factors such as race, age, and obesity, children with OSA had a higher risk of viral respiratory infections, with influenza and COVID-19, and were more likely to develop severe complications, specifically pneumonia due to these viruses
MedicalResearch.com: Are these children also at increased risk of ear infections?
Response: It is well established that increased adenoids , the main cause of OSA in children, block ear canal and lead to ear infections.
MedicalResearch.com: Why would adenotonsillectomy not improve the sleep apnea? What else might work?
Response: We should rememeber that although this is the largest study of its kind it is still retrospective so we can’t really be certain about the effect of treatment (as opposed to clinical trial). Having said that, we know that 20-30% of children remain with OSA even after surgery and in addition there are epigentic changes due to long standing hypoxia and sleep disturbance that we find in preclinical studies. These changes may perpetuate the increased susceptability to viral infection.
MedicalResearch.com: What should readers take away from your report?
Response: Overall, OSA is a common pediatric condition and primary pediatricians should be on the lookout to identify it since it leads to many unwanted outcomes, adding viral infection susceptibility to those. Also, as we advocate for vaccination for seasonal flu for children at risk (like those with asthma or prematurity), children with OSA should be added to this group of increased risk.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: Why this phenomenon is happening is not entirely clear and we are trying to understnd it on the molecular level – how sleep disruption and low oxygen during sleep (each by itself and together) can impair the immune response. Also what is the effect of vaccination on mitigating this excess risk was not examined in this study and we are planning on looking at it.
Finally, whether adults with OSA or other sleep disorders suffer from similar susceptability is being currently tested.
No disclosures
Citation:
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. 2026 Feb 11;22(1):31. doi: 10.1007/s44470-025-00035-x. PMID: 41678041.
https://pubmed.ncbi.nlm.nih.gov/41678041/
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Last Updated on February 18, 2026 by Marie Benz MD FAAD
