Untreated obstructive sleep apnea is associated with increased hospitalization from influenza infection

There is evidence that sleep deprivation or diseases such as obstructive sleep apnea (OSA) that lead to sleep disruption may adversely impact immune system functioning. We hypothesized that individuals who have OSA who did not use continuous positive airway pressure (CPAP) would have higher rates of hospitalization and complications from influenza infection than patients with OSA who were adherent to treatment.

Medical records of patients at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire who had both OSA and a new, laboratory-confirmed influenza infection between 2016 and 2018 were reviewed for results of polysomnography, CPAP usage, influenza vaccination records, confirmation of influenza infection, and influenza-related hospitalizations and complications.

Compared to the patients who were adherent to CPAP, patients who were either conservatively treated without CPAP or who were nonadherent to CPAP therapy had higher odds of hospitalization from influenza infections (odds ratio = 4.7, 95% confidence interval 1.3 to 19.5, P = .01) but no higher odds of complications from influenza. The patients who had untreated sleep apnea had a higher percentage of influenza vaccination for their season of illness (75% of patients) compared to patients who were adherent to CPAP (56% of patients), although the difference in vaccination was not statistically significant.

Patients with OSA who did not use CPAP appear to have greater rates of hospitalization from acute influenza infection, despite having a higher trend of influenza vaccination compared to patients who were adherent to CPAP.