Pediatric obstructive sleep apnea affects approximately 1-5 percent of children, most commonly in the 2-8 age range when tonsillar and adenoidal tissue is largest relative to airway size (American Academy of Pediatrics). It is often underdiagnosed because daytime symptoms in children look different from adults -- behavioral and attention issues rather than sleepiness.

Common signs include loud habitual snoring, witnessed breathing pauses or gasping, restless sleep, bedwetting beyond expected age, mouth breathing, attention or behavioral issues, hyperactivity (rather than sleepiness), poor school performance, and morning headaches. Snoring alone does not confirm OSA -- a sleep study is required for diagnosis.

For otherwise healthy children with enlarged tonsils and adenoids, the AAP and American Academy of Otolaryngology recommend adenotonsillectomy as first-line therapy. Surgery resolves OSA in approximately 70-80 percent of cases. Children with obesity, craniofacial issues, or Down syndrome may have residual OSA after surgery and require additional treatment.

CPAP is typically prescribed for pediatric patients with persistent moderate-to-severe OSA after adenotonsillectomy, those with craniofacial abnormalities or neuromuscular conditions, children with Down syndrome and significant residual OSA, or patients in whom surgery is not appropriate. Pediatric CPAP requires pediatric sleep medicine specialty care.

No. Both the American Academy of Pediatrics and the American Academy of Sleep Medicine recommend an in-lab polysomnogram (PSG) for diagnosing OSA in children under 18. Home sleep apnea tests are validated for adults and are not reliable in pediatric patients due to differences in normal breathing patterns and arousal thresholds.