Obstructive Sleep Apnea and Risk of Respiratory Syncytial Viral Infection: A Retrospective Multi-Institution Cohort Study

Abstract

This retrospective cohort study evaluated the association between obstructive sleep apnea (OSA) and the risk of respiratory syncytial virus (RSV) infection and its complications using data from the TriNetX US Collaborative Database. Patients diagnosed with OSA (n = 1 061 261) and matched controls (n = 3 479 494) were identified via ICD-10-CM codes. Propensity score matching adjusted for 19 covariates to balance baseline characteristics. Over a follow-up period ranging from 1 day to 1 year post-index, patients with OSA demonstrated a significantly higher incidence of RSV infection (0.18% vs. 0.08%; HR: 2.194, 95% CI: 2.025–2.378, p < 0.0001). Additionally, patients with OSA exhibited increased risks for severe RSV-related complications, including respiratory failure (HR: 1.291, 95% CI: 1.147–1.453), hospitalization (HR: 1.114, 95% CI: 1.026–1.210), and admission to critical care (HR: 1.329, 95% CI: 1.118–1.579). Sensitivity analyses confirmed the robustness of these findings across various observation periods, database subsets, study timelines, and inclusion criteria. Subgroup analyses stratified by age and gender also consistently supported the primary results. These findings suggest that OSA is associated with elevated risks of RSV infection and related severe outcomes, indicating the need for further studies to validate these results and potentially classify OSA patients as a high-risk group for RSV infection.