February 23, 2026 – Children with sleep apnea are twice as likely to contract the flu or COVID-19, regardless of their age or weight, compared to children who sleep normally, according to a new five-year study by researchers at the Hebrew University of Jerusalem (HU).

The research, published in the Journal of Clinical Sleep Medicine, reveals sleep apnea also impacts the immune system, even after children undergo surgery to remove tonsils or adenoids. These findings suggest that a sleep apnea diagnosis should serve as a critical “risk marker,” signaling the urgent need for consistent seasonal vaccinations to prevent severe respiratory complications.

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 Obstructive sleep apnea (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

According to Dr. Alex Gileles-Hillel, along with Dr. Joel Reiter from the Hadassah – Faculty of Medicine at the Hebrew University, “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.”

Many parents opt for an adenotonsillectomy (the removal of tonsils and adenoids) to treat their child’s sleep apnea, which causes snoring and daytime fatigue. 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.”

The research paper titled “Risk of influenza and COVID-19 illness and pediatric obstructive sleep apnea: a TriNetX cohort with 5-year follow-up” is now available in Journal of Clinical Sleep Medicine and can be accessed here.

Researchers:

Alex Gileles-Hillel1,2, Joel Reiter1,2, David Gozal3

Institutions:

  1. Faculty of Medicine, The Hebrew University, Jerusalem, Israel
  2. Paediatric Pulmonology and Sleep Unit, Paediatric Division, Hadassah Medical Center, Jerusalem, Israel
  3. Office of The Dean and Departments of Paediatrics and Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA