Jerusalem, 18 February, 2026 (TPS-IL) — Children diagnosed with obstructive sleep apnea face a significantly higher risk of contracting influenza and COVID-19, even years after treatment, according to a large international study that tracked pediatric patients over five years, Israeli and U.S. scientists announced on Wednesday. Researchers say the findings underscore the need to treat sleep apnea as a warning sign for heightened vulnerability to respiratory viruses and to prioritize preventive care.
Sleep apnea is a sleep disorder in which breathing repeatedly pauses or becomes very shallow during sleep, disrupting oxygen levels and causing fragmented rest. It is most commonly caused by muscles at the back of the throat relaxing too much and blocking the airway (obstructive sleep apnea, or OSA). However apnea can also be caused by enlarged tonsils or adenoids, excess weight, nasal obstruction, or structural differences such as a small jaw or large tongue.
If untreated, sleep apnea strains the heart, raises blood pressure, and impairs metabolic and immune function. Recent research shows that this immune dysregulation makes Children with sleep apnea significantly more vulnerable to respiratory infections such as influenza and COVID-19, and more likely to develop complications like pneumonia. Because the brain receives less oxygen during sleep, behavioral and cognitive issues are also common.
Treatment depends on age and severity and can include lifestyle changes such as weight management and sleep position, the use of machines to maintain airway pressure, surgical removal of tonsils and adenoids in children, oral appliances that reposition the jaw or tongue, and, in some cases, medications to address underlying conditions like nasal inflammation.
Sleep apnea manifests differently in children and adults. Adults often experience loud, chronic snoring, excessive daytime sleepiness, mood changes, difficulty concentrating, and morning headaches. Children, however, may also display behavioral changes such as hyperactivity, inattention, or poor school performance.
Using data from a global health research database, the Israeli and American scientists analyzed medical records from more than one million children between the ages of 2 and 18 over a five-year period. The analysis found that children with obstructive sleep apnea (OSA) were about twice as likely to be diagnosed with influenza or COVID-19 compared to children without sleep disorders, regardless of age or body weight. The risk for COVID-19 was particularly high, with affected children about two and a half times more likely to contract the virus. Children with sleep apnea were also significantly more likely to develop pneumonia as a complication of these viral infections.
The study was led by Dr. Alex Gileles-Hillel and Dr. Joel Reiter from the Faculty of Medicine at the Hebrew University, together with senior pediatric pulmonologists from Hadassah Medical Center, in collaboration with Dr. David Gozal of Marshall University. The findings were published in the peer-reviewed Journal of Clinical Sleep Medicine.
Importantly, the study found that the elevated risk persisted even among children who had undergone adenotonsillectomy, a common surgical procedure to remove the tonsils and adenoids and relieve airway obstruction during sleep. This suggests that surgery alone may not eliminate vulnerability. “This may reflect two clinical and pathophysiological observations,” Gozal said. “First, a significant proportion of children experience residual sleep apnea after the procedure. Second, OSA-related immune dysregulation could impair the recruitment of an appropriate immune response. We are actively working on understanding this immune-related susceptibility.”
The study suggests that a diagnosis of pediatric sleep apnea should serve as a clear “risk marker” for severe viral infections, signaling the need for closer medical attention even after surgery. Children with sleep apnea should be prioritized for seasonal influenza and COVID-19 vaccinations to reduce their higher likelihood of infection and complications. In addition, doctors are encouraged to continue monitoring these children beyond surgical treatment, tracking their sleep quality, respiratory health, and overall immune function to ensure ongoing protection against illness.
“Sleep apnea should not be viewed only as a quality-of-life issue. It is a measurable risk factor for serious viral infections and their complications, and clinicians should use it as a predictive flag for preventive care,” Reiter said.
The study was published in the peer-reviewed Journal of Clinical Sleep Medicine.
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