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The Interplay Between Obstructive Sleep Apnea and Respiratory Infections: A Review Article.

Safy Kaddah¹, Antonio M Esquinas²

¹Department of Chest Diseases, Cairo University, Kasr Alainy Hospital Faculty of Medicine, Giza, Egypt.

Thoracic Research and Practice

|March 3, 2026

Summary

Obstructive sleep apnea (OSA) increases the risk of lower respiratory tract infections (LRTIs) due to inflammation and impaired immunity. CPAP therapy may help, but hygiene is crucial to prevent infection spread.

Keywords:

COVID-19 CPAP therapy Obstructive sleep apnea airway microbiota community-acquired pneumonia immune dysregulation lower respiratory tract infections

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Published on: October 18, 2024

Area of Science:

Pulmonology
Sleep Medicine
Infectious Disease

Background:

Obstructive sleep apnea (OSA) is a common sleep disorder linked to airway collapse and intermittent hypoxia.
Emerging evidence indicates a significant association between OSA and lower respiratory tract infections (LRTIs).

Purpose of the Study:

To explore the bidirectional relationship between OSA and LRTIs.
To elucidate the underlying pathophysiological mechanisms connecting OSA and increased infection susceptibility.
To review the impact of OSA on infection severity and recovery.

Main Methods:

Review of observational studies and epidemiological data.
Analysis of pathophysiological mechanisms including inflammation, immune dysregulation, and impaired airway defenses.
Evaluation of Continuous Positive Airway Pressure (CPAP) therapy's role in mitigating infection risk.

Main Results:

Individuals with untreated OSA exhibit higher rates of pneumonia and more severe infections.
Mechanisms include systemic inflammation, immune dysfunction, impaired mucociliary clearance, and microaspiration.
CPAP may reduce infection risk, but device hygiene is critical.

Conclusions:

OSA is an underrecognized risk factor for LRTIs, driven by shared pathophysiological pathways.
Understanding this link can inform infection prevention strategies for at-risk populations.
Further research is needed to optimize management and reduce infection burden in OSA patients.