Sleep Apnea and Risk of Influenza-Associated Severe Acute Respiratory Infection: Real-World Evidence

Abstract

Purpose We executed the presented retrospective cohort study with the purpose of probing the risk of severe acute respiratory infection (SARI) following influenza in patients with sleep apnea. Materials and Methods We executed this real-world study by gathering Taiwan National Health Insurance Research Database (NHIRD) data. From a database containing 1 million individuals sampled at random from the NHIRD, we identified all patients aged 20 years or older with a sleep apnea diagnosis between 1997 and 2013 as the study group. We established a comparison cohort of individuals without sleep apnea by randomly matching patients with respect to monthly income, gender, urbanization level, and age at a 1:4 ratio. Follow-up was performed until death or the end of 2015 for both groups. We determined the study outcome to be the occurrence of influenza-associated SARI. Results We enrolled 6508 and 26,032 patients into the study and comparison groups, respectively. A significantly higher cumulative incidence of influenza-associated SARI was discovered in the study group ( p < 0.001). In our multivariate analysis, sleep apnea, chronic obstructive pulmonary disease, and coronary artery disease were independent risk factors for influenza-associated SARI. The hazard ratio of sleep apnea for influenza-associated SARI was 1.98 (95% CI: 1.26–3.10) after adjustment for all comorbidities, gender, age, monthly income, and urbanization level. Conclusion Sleep apnea increased the risk of influenza-associated SARI. We suggest that physicians be cautious about the development of severe influenza illness in patients with sleep apnea. Vaccination and early oseltamivir administration should be actively considered in this group of patients.

Impact of obstructive sleep apnea on clinical outcomes of hospitalization due to influenza in children: A propensity score‐matched analysis of the US Nationwide Inpatient Sample 2005–2018

“…After multivariate analysis, sleep apnea increased the risk of influenza-associated SARI. 12 Our data, from a nationally representative data set of 25,328 children, lend support to that argument in the pediatric population.…”

“…Previous retrospective studies demonstrated the significance of OSA appearing to have higher rates of hospitalization from acute influenza infection in the adult population. 9,11,12 Previous studies have reported that OSA is associated with influenza infection and hospitalization due to influenza in the adult population. Tsai et al…”

“…The age distribution of children hospitalized with or without OSA is depicted in Figure 2. A greater proportion of children aged [11][12][13][14][15] was seen in the OSA group (Figure 2).…”

“…Specifically, a greater incidence of influenza infection and hospitalizations related to influenza in patients with OSA. [9][10][11][12] However, these studies mostly focused on the adult population. It is unclear whether and how OSA affects the outcomes of pediatric influenza hospitalizations.…”

Associations Between Obstructive Sleep Apnea (OSA) and COVID-19 Infection and Hospitalization Among U.S. Adults <strong> </strong>

“…Our results are consistent with many other studies demonstrating that OSA appears to be a risk factor for COVID-19 infection or hospitalization [5][6][7][8]10,12,[14][15][16][17]31,32 as for influenza. 33 However, these prior studies utilized hospital records or other databases to identify COVID-19 cases with or without OSA and in some cases were susceptible to collider bias. In contrast, our data are derived from a large general population survey.…”