Chen Lan, Zhang Sun, Chen Zhao, Cheng Jinling, Chen Canjie, Tang Tian, Zhao Jingxian, Zhao Jincun, Zhong Nanshan, Zhang Nuofu, Zhu Airu
State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, National Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangzhou National Laboratory, Guangzhou International Bio Island, Guangzhou, China.
J Thorac Dis. 2025 Aug 31;17(8):5610-5625. doi: 10.21037/jtd-2025-391. Epub 2025 Aug 28.
Obstructive sleep apnea (OSA) is a common disorder linked to immune dysregulation and increased risk of severe coronavirus disease 2019 (COVID-19) outcomes. While vaccination is essential for preventing infection and severe disease, the impact of OSA on vaccine efficacy remains underexplored. This study examines the effects of OSA on immune responses following the third dose of the inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine (CoronaVac or BBIBP-CorV).
A total of 97 severe OSA participants with apnea-hypopnea index (AHI) >30 events/hour, and 88 healthy donors (HDs) were enrolled. Among the OSA participants, 43 individuals without symptomatic treatment before and during follow-up were designated as the untreated OSA group, while 41 participants receiving positive airway pressure (PAP) prior to the third COVID-19 vaccine dose were categorized as the treated OSA group. Full-night polysomnography (PSG) was performed to assess OSA severity. Neutralizing antibody (nAb) levels and cellular immune responses were analyzed at multiple time points following booster vaccination.
Immune responses in untreated OSA participants were inversely associated with disease severity. Specifically, untreated OSA participants with AHI >50 events/hour exhibited significantly reduced nAb titers, antibody-secreting cell (ASC) frequencies, and circulating T follicular helper (cTfh) cells, indicating impaired immune recall responses. In contrast, PAP-treated OSA participants demonstrated improved humoral responses, notably at peak immune response stages.
These findings highlight a severity-dependent impairment of vaccine-induced immune responses in untreated OSA participants, with evidence that PAP treatment may enhance vaccine efficacy. This study emphasizes the need to consider OSA severity and treatment when optimizing vaccination strategies for this population.
阻塞性睡眠呼吸暂停（OSA）是一种常见疾病，与免疫失调以及2019年冠状病毒病（COVID-19）严重后果风险增加有关。虽然疫苗接种对于预防感染和重症疾病至关重要，但OSA对疫苗效力的影响仍未得到充分研究。本研究考察了OSA对灭活严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗（科兴新冠疫苗或BBIBP-CorV）第三剂接种后免疫反应的影响。
共纳入97名呼吸暂停低通气指数（AHI）>30次/小时的重度OSA参与者和88名健康供者（HD）。在OSA参与者中，43名在随访前和随访期间未接受对症治疗的个体被指定为未治疗OSA组，而41名在第三剂COVID-19疫苗接种前接受气道正压通气（PAP）治疗的参与者被归类为治疗OSA组。进行整夜多导睡眠图（PSG）检查以评估OSA严重程度。在加强接种后的多个时间点分析中和抗体（nAb）水平和细胞免疫反应。
未治疗的OSA参与者的免疫反应与疾病严重程度呈负相关。具体而言，AHI>50次/小时的未治疗OSA参与者表现出nAb滴度、抗体分泌细胞（ASC）频率和循环滤泡辅助性T细胞（cTfh）显著降低，表明免疫回忆反应受损。相比之下，接受PAP治疗的OSA参与者表现出改善的体液反应，尤其是在免疫反应高峰期。
这些发现突出了未治疗的OSA参与者中疫苗诱导的免疫反应存在严重程度依赖性损害，有证据表明PAP治疗可能提高疫苗效力。本研究强调在优化该人群的疫苗接种策略时需要考虑OSA的严重程度和治疗情况。
