OSAS is an underrecognized but clinically important respiratory disorder in children. OSAS is characterized by intermittent, complete, or partial upper airway obstruction during sleep, sometimes with associated hypoxemia or carbon dioxide retention. In children, the prevalence of OSAS is 1% to 3%, with the peak incidence in preschool-aged children.

The most common symptom of OSAS in children is snoring. Snoring affects 7% to 9% of children younger than age 10. Unfortunately, there is no reliable screening test to differentiate primary snoring from OSAS. Other symptoms consistent with OSAS include restless sleep; difficulty with or irritability upon awakening; mouth breathing; and behavioral problems, such as hyperactivity and aggression. In severe cases, untreated OSAS can lead to learning difficulties, developmental delay, failure to thrive, pulmonary hypertension, cor pulmonale, and congestive heart failure. According to the American Academy of Pediatrics’ practice guidelines for OSAS, pediatricians should consider the possibility of OSAS in any child presenting with snoring. If other signs or symptoms of OSAS are also present, further investigation should be undertaken.

The usual etiologies of OSAS can be divided into anatomic versus functional problems, all of which result in airway occlusion, narrowing, or collapse. Anatomic causes include both bony and soft tissue abnormalities. Many genetic syndromes are associated with craniofacial anomalies, such as micrognathia (e.g., Pierre Robin sequence, Treacher Collins syndrome), midface hypoplasia and deformities of the skull base (e.g., Down syndrome, Pfeiffer syndrome).