Researchers from Taiwan report that Children hospitalized with enterovirus infection have an increased incidence of obstructive sleep apnea ( OSA ). The study was published in the  Pediatric Infectious Disease Journal.

Dr. Chung-Yao Hsu from Kaohsiung Medical University Hospital said, "We recommend all patients with enterovirus infection, particularly those who have been hospitalized, should receive a regular follow-up after discharge for their breathing pattern during sleep and associated daytime symptoms in order to detect OSA earlier. " 

Sleep disturbance is common in the pediatric population, and enterovirus infection is known to be associated with systemic disorders and neurological sequelae. Whether sleep disorders and viral infections are associated remains unclear.

Dr. Hsu and colleagues used data from the Taiwan National Health Insurance Research Database to find out whether enterovirus infection in children under 18 is linked to sleep disorders. They identified some 48,000 children with a history of enterovirus infection and an equally sized matched control group.

Of the 1,903 children with a diagnosis of a non-apneic sleep disorder during the study follow-up period, 1,016 had a history of enterovirus infection and 887 did not. During the surveillance period, 316 children were diagnosed with OSA: 182 with enterovirus infection and 134 without.

During a mean follow-up of more than 9.5 years, enterovirus infection, with or without hospitalization , was not independently associated with non-apneic sleep disorders, after adjustment for other factors.

In contrast, enterovirus infection with hospitalization was significantly associated with a 62% increased risk of OSA (P = 0.003). Enterovirus infection was not significantly associated with OSA, whereas allergic rhinitis was associated with a 4.82-fold increased risk for OSA.

"Our data provide rationale for monitoring individuals with severe infections who have been hospitalized with enterovirus infections or present with allergic rhinitis , with regular follow-up by health care providers vigilant for the emergence of sleep symptoms and disorders," the researchers conclude. .

"OSA is a clinically treatable sleep disorder which is easily neglected by general health professionals, with negative cognitive, behavioral, metabolic, and cardiovascular outcomes without treatment," Dr. Hsu said.

Dr. Howard Faden from State University of New York, in Buffalo, who was not involved in the new work, reported on the ubiquity of asymptomatic viral infections in children with sleep-disordered breathing. I have added, "It is possible that the situation in Taiwan and Asia in general may be very different than in the US"

Furthermore, Epstein-Barr virus ( EBV ) has much more potential to cause nasopharyngeal cancer in Asia than in the US, suggesting that the host response to the virus may be very different. "

Dr. Faden said that in his study, "EBV and adenovirus were the big players in OSA, depending on whether you are discussing the case in EBV or the adenoid in the case of adenovirus," he said. "I was actually very surprised by the number of other viruses detected in children who were not acutely ill at the time of their surgeries ."