Childhood obstructive sleep-disordered breathing: A clinical update and discussion of technological innovations and challenges

Childhood sleep-disordered breathing (SDB) has been known to be associated with health and cognitive impacts for more than a century, and yet our understanding of this disorder is in its infancy. Neuropsychological consequences in children with snoring or subtle breathing disturbances not meeting the traditional definition of sleep apnea suggest that "benign, or primary snoring" may be clinically significant, and that the true prevalence of SDB might be underestimated. There is no standard definition of SDB in children. The polysomnographic technology used in many sleep laboratories may be inadequate to diagnose serious but subtle forms of clinically important airflow limitation. In the last several years, advances in digital technology as well as new observational studies of respiratory and arousal patterns in large populations of healthy children have led to alternative views of what constitutes sleep-related breathing and arousal abnormalities that may refine our diagnostic criteria. This article reviews our knowledge of childhood SDB, highlights recent advances in technology, and discusses diagnostic and treatment strategies that will advance the management of children with pediatric SDB.