Association between autoimmune disease and obstructive sleep apnea in a pediatric population

Autoimmune diseases (AD) and Obstructive Sleep Apnea (OSA) both involve systemic inflammation, though their relationship is unclear. This study evaluates the association between AD and OSA, identifies specific associated ADs, and examines tonsillectomy rates and post-tonsillectomy bleeding in pediatric patients with and without AD.

This retrospective analysis used the TriNetX United States Collaborative Network database, focusing on pediatric patients aged 2-17 years with outpatient visits. After identifying over 7.3 million patients, children with 18 specific ADs were matched 1:1 by age, sex, race, and ethnicity with non-AD controls. The primary analysis assessed the odds of having OSA in patients with and without AD. Additionally, we examined the rates of tonsillectomy and the likelihood of post-tonsillectomy bleeding in OSA patients with and without AD.

160,517 patients with AD were matched with 160,517 patients without AD. Mean age is 4.2 years and mostly female (81,157, 50.6%). AD patients were significantly more likely to have OSA (OR = 2.283 ± 0.08, p < .0001). Strongest associations were found with necrotizing vasculopathy (OR = 3.571 ± 0.87), connective tissue disease (OR = 3.103 ± 0.30), multiple sclerosis (OR = 3.037 ± 1.07), systemic lupus erythematosus (OR = 2.644 ± 0.83), rheumatoid arthritis (OR = 2.406 ± 0.68), and ulcerative colitis (OR = 2.377 ± 0.45) (p < .001 for all). OSA patients with AD were less likely to undergo tonsillectomy (3752 (39.7%) vs. 3975 (42.0%), OR = 0.91 ± 0.05, p = .001) but faced a higher post-tonsillectomy bleeding risk (232(5.7%) vs. 177(4.4%), OR = 1.33 ± 0.24, p = .005).

Children with AD are more likely to have OSA than children without AD, emphasizing the need for careful management, especially when surgical options are considered.