Incidence of Pediatric Sleep Apnea
Pediatric obstructive sleep apnea affects 1-5% of the general pediatric population, with peak prevalence occurring between ages 2-8 years. 1
Prevalence Data
The most recent American Thoracic Society guidelines from 2024 report that pediatric OSA is prevalent in up to 5% of children overall. 1 This aligns with the 2015 American Thoracic Society statement citing an estimated prevalence range of 1-5% in the general pediatric population. 1
Age-Related Patterns
- Peak incidence occurs at 2-8 years of age, corresponding to the period of maximal adenotonsillar growth relative to airway size. 1
- This age distribution pattern may be shifting due to the increasing prevalence of childhood obesity, which is becoming a more dominant risk factor across all age groups. 1
High-Risk Populations with Elevated Prevalence
Certain subgroups demonstrate substantially higher rates than the general population:
Obesity-Related OSA
- 50% prevalence in obese children, representing a dramatic increase compared to normal-weight peers. 1
Genetic and Syndromic Conditions
- 50% prevalence in Down syndrome (trisomy 21). 1
- Children with craniofacial syndromes, Beckwith-Wiedemann syndrome, achondroplasia, and mucopolysaccharidoses show elevated risk. 1
Medical Complexity
- Children with chronic cardiopulmonary disorders, neuromuscular diseases, cerebral palsy, and myelomeningocele demonstrate increased prevalence. 1
Severe Baseline OSA
- 10-15% prevalence in children with baseline severe OSA (obstructive apnea-hypopnea index >10/hour). 1
Prader-Willi Syndrome
- More than 80% of children with PWS exhibit sleep-disordered breathing including OSA. 1
- 43% of infants with PWS have central sleep apnea, compared to approximately 5% in children ages 2-18 years. 1
Racial and Ethnic Disparities
- Asian children, particularly East Asian, face elevated risk at equivalent obesity levels due to craniofacial structural differences. 1
- African American children in the United States demonstrate higher prevalence rates. 1
Persistent Post-Surgical OSA
- Up to 40% of children develop persistent OSA after adenotonsillectomy, leaving approximately 2% of all children at risk for this condition. 1
- This persistence rate is particularly high in obese children (50%), those with severe baseline OSA, and children with medical complexity or genetic disorders. 1
Clinical Implications
The global childhood obesity epidemic and improved survival of children with medical complexities are driving a significant and increasing number of children with persistent, severe, and untreated OSA into adulthood, creating a substantial public health concern. 1 More than 80% of sleep apnea remains undiagnosed in the general population, which has serious implications for long-term cardiovascular, neurocognitive, and metabolic health. 1