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

Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse, intermittent hypoxia, and sleep fragmentation. Increasing evidence suggests a bidirectional association between OSA and lower respiratory tract infections (LRTIs), including pneumonia, bronchitis, and exacerbations of chronic lung disease. Multiple mechanisms may underlie this relationship. Intermittent hypoxia and sleep disruption promote systemic inflammation and immune dysregulation. Impaired mucociliary clearance, microaspiration, alterations in airway microbiota, together with obesity and related comorbidities, further contribute to increased susceptibility to and severity of infections. Observational studies demonstrate that individuals with untreated OSA have higher rates of pneumonia, more severe infections, and delayed recovery from infections compared with non-OSA populations. These risks are particularly evident among older adults and patients with cardiopulmonary comorbidities. Continuous positive airway pressure (CPAP) therapy may mitigate infection risk by maintaining airway patency, reducing hypoxemia, and improving mucociliary clearance. However, concerns remain regarding CPAP device-associated microbial colonization, highlighting the importance of strict hygiene practices and equipment maintenance. OSA appears to be an underrecognized risk factor for LRTIs; this association is driven by overlapping pathophysiological mechanisms and is supported by emerging epidemiological data. Recognizing this interplay may guide infection prevention strategies and improve clinical outcomes in high-risk populations.