Pediatric sleep apnea associated with low vitamin D – many countries, Egypt 2026
Association between serum vitamin D and obstructive sleep apnea syndrome in children: a case–control study
The Egyptian Journal of Otolaryngology, July 2026, https://doi.org/10.1186/s43163-026-01173-6
Yasser Mohamed ElBeltagy, Marwa Mohamed El Begermy, Tarek Abd Elhamid Mohamed, Rasha Ahmed Ghorab, Karim Hossam Soliman, Mena Maher Nassif
Summary by Claude - July 2026
The practical takeaway: in this Egyptian study, children screened as likely to have obstructive sleep apnea (OSA) were about five times as likely to be severely vitamin D deficient as matched healthy children. This was an observational case–control study of 84 children aged 2–16 (42 likely-OSA cases, 42 controls), with apnea risk judged by the validated Arabic SRBD-PSQ caregiver questionnaire rather than by an overnight sleep study.
Mean 25(OH)D was 23.9 ng/mL in the apnea group versus 28.2 ng/mL in controls (p=0.021). Severe deficiency (<20 ng/mL) affected 47.6% of cases but only 9.5% of controls (p=0.001). In both groups, lower vitamin D tracked with worse apnea-symptom scores (Spearman −0.49 in cases, −0.53 in controls), hinting at a dose–response pattern. Groups were matched for age, sex, and BMI, so those did not explain the gap. The direction agrees with earlier pediatric findings from Italy, the United States, and Korea.
What this does not show / limitations: It cannot show that low vitamin D causes sleep apnea — the design is cross-sectional, so low levels could instead result from less outdoor activity in symptomatic children. Apnea was screened by questionnaire, not confirmed by polysomnography, so some children may be misclassified. Sun exposure, diet, and physical activity were not measured; it was a single unadjusted blood draw at one hospital; and many subgroup tests were run without correction for multiple comparisons. The authors call the findings hypothesis-generating and stop short of recommending vitamin D testing in apnea workups — while noting that correcting deficiency is low-cost and low-risk regardless.
| Study / Country | Design (OSA confirmed how) | Sample | Vitamin D difference | Severity relationship |
|---|---|---|---|---|
| ElBeltagy 2026 — Egypt | Case-control, SRBD-PSQ screen (no PSG) | 42 OSAS / 42 controls, age 2–16 | Mean 23.94 vs 28.18 ng/mL (p=0.021); severe deficiency <20: 47.6% vs 9.5% (p=0.001) | Spearman rₛ −0.487 (cases), −0.526 (controls) vs SRBD-PSQ score |
| De Luca 2023 — Italy | Prospective case-control, clinical ATH-OSA | cases vs sex/age/ethnicity-matched controls | Mean 17 vs 22 ng/mL (p<0.0005) | Brodsky grade III vs IV: not significant |
| Locci 2023 — Italy | Retrospective observational, overnight polygraphy | 127 children with OSAS, age 2–14 | inverse vs hypoxia burden | vitamin D inversely proportional to AHI, ODI, and time with SpO₂ <90% |
| Italian cohort 2026 (J Clin Med) | Case-control, PSG-confirmed | 138 OSA / 138 matched controls | inverse | AHI vs vitamin D R=−0.37; ODI R=−0.36 (both p<0.0001), surviving adjustment for sex, age, BMI, insulin resistance |
| JAMA Oto 2024 — USA (Norfolk, VA) | Cross-sectional, PSG | 72 children, severe OSA, age 2–16; 37.5% deficient | deficient vs normal | mean obstructive AHI 46.0 (deficient) vs 35.9 (normal); dose-dependent — a 1-unit drop in 25(OH)D linked to a 0.7 rise in AHI |
| Kheirandish-Gozal — USA (Chicago) | Cross-sectional, PSG | 176 children, mean age 6.8 y | lower 25(OH)D in OSAS, obese, and African American children | 25(OH)D correlated with BMI z-score, hs-CRP, HOMA-IR, AHI, and SpO₂ nadir |
| Chae 2021 — Korea (no checked) | Observational | children with sleep-disordered breathing | deficiency in >50% | inverse vitamin D–AHI, r=−0.22 (p=0.02) |
| Study reviewed in Locci | Comparative, split at 20 ng/mL | 240 children, age 7–14 (120 <20 ng/mL vs 120 ≥20) | — | OSAS risk significantly higher in the low-vitamin-D group (p=0.030) |