Association Between Autoimmune Disease and Obstructive Sleep Apnea in Children

Saturday, October 11, 2025

4:36 PM - 4:42 PM EDT

Location: 136

Introduction: Autoimmune diseases (AD) and Obstructive Sleep Apnea (OSA) both involve systemic inflammation, yet their relationship remains unclear. This study determines if there is an association between AD and OSA, identifies specific associated ADs, and examines differences in tonsillectomy (including adenotonsillectomy) rates and post-tonsillectomy bleeding rates in pediatric patients with and without AD.

Methods: This retrospective analysis used the TriNetX United States Collaborative Network database, focusing on pediatric patients aged 2–17 years with outpatient visits from 2009 to 2024. Children with 18 specific ADs were matched 1:1 by age, sex, race, and ethnicity with non-AD controls. The primary analysis assessed the OSA odds in patients with and without AD. Secondary analyses explored tonsillectomy rates and post-tonsillectomy bleeding risks in OSA patients.

Results: A total of 210,804 patients with AD were matched to 210,804 patients without AD. 52.2% (N=109,941) patients were female and 46.6% (N=98,2870) were male with a mean age of 4.9 years. AD patients had significantly higher odds of OSA (OR= 2.253±0.07, p<.0001). Strongest associations were with autoimmune thyroiditis (OR=3.765±0.41), 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), and rheumatoid arthritis (OR=2.406±0.68) (p <.001 for all). OSA patients with AD were less likely to undergo tonsillectomy (N=4,505 [39.2%] vs. 4,737 [41.2%], OR=0.92±0.05, p=.002) but had a higher post-tonsillectomy bleeding risk (N=225 [5.7%] vs. 170 [4.3%], OR=1.34±0.25, p=.005).

Conclusions: Pediatric patients with AD are at greater risk for OSA and post-tonsillectomy bleeding yet are less likely to undergo tonsillectomy. This disparity may reflect perceived surgical risks, comorbidities, or delayed/missed diagnoses, particularly in older children who may trial CPAP. These findings emphasize the need for proactive screening, individualized management, and a cautious approach to surgical interventions in this population.

Presenting Author(s)

JS

Joshua Sorrentino, BS

Medical Student
Jacobs School Medicine and Biomedical Sciences at the University at Buffalo, United States

Disclosure information not submitted.

Co-Author(s)

Brynn S. Franz, BS

Medical Student
University of South Carolina SOM
Columbia, SC, United States

Disclosure information not submitted.
GV

Gaayathri Varavenkataraman, MA

Research Assistant
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
East Amherst, New York, United States

Disclosure information not submitted.
Tony Han, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, NY, United States

Disclosure information not submitted.
Ellen M. Piccillo, MD

Resident Physician
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure information not submitted.

Senior Author(s)

MC

Michele M. Carr, DDS MD PhD

Professor
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Williamsville, New York, United States

Disclosure information not submitted.