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Increased Incidence of Obstructive Sleep Apnea in Hospitalized Children following Enterovirus Infection: A Nationwide Population-Based Cohort Study

Chen Vincent Chin-Hung MD PhD; Yang, Yao-Hsu MD; Kuo, Ting-Yu MS; Huang, Kuo-You PhD; Huang, Yin-Cheng MD, PhD; Lee, Yena; McIntyre, Roger S. MD, PhD; Huang, Yu-Shu MD; Hsu, Chung-Yao MD, PhD
The Pediatric Infectious Disease Journal: Post Acceptance: January 08, 2018
doi: 10.1097/INF.0000000000001892
Original Studies: PDF Only


We report the first nationwide population-based cohort study using Taiwan’s National Health Insurance Research Database on the association between enterovirus infection and the incidence of sleep disorders in a pediatric population.


Two matched groups of children under 18 years of age were included in the analyses for non-apneic sleep disorder and obstructive sleep apnea (OSA). Among them, 316 subjects were diagnosed with OSA during the surveillance period, including 182 in the EV infection group and 134 in the non-EV infection group.


Hospitalization due to EV infection was associated with OSA after adjusting for age, sex, urbanization atopic disease and perinatal complications (adjusted hazard ratio = 1.62, 95% CI: 1.18-2.21, p = 0.003). An additional factor significantly associated with sleep apnea were allergic rhinitis (hazard ratio = 4.82, 95% CI: 3.45-6.72).


Children with severe EV infection (i.e. requiring hospitalization) carry a significantly higher risk of developing OSA, particularly in those with allergic rhinitis. As pediatric obstructive sleep apnea is a treatable sleep disorder, we emphasize regular follow-up and early detection in children with EV infection.

Funding source: No funding was secured for this study

Financial Disclosure: All authors have no financial relationships relevant to this article to disclose.

Address correspondence to Chung-Yao Hsu, MD, PhD, Department of Neurology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Kaohsiung 804, Taiwan (, 00886-7-3121101-6839

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