Obstructive sleep-disordered breathing in children: new controversies, new directions.

Although it may seem that confusion and uncertainty reign in the field of pediatric sleep medicine, the recent realizations that the scope of childhood SDB is wider, the symptomatology is broader, and the prevalence is higher than previously believed are major advances. Likewise, recent acknowledgment of the lack of true "gold standards" for diagnosing UARS and OSAS in children is also a major advancement in this field. Critical assessment of the current "state of the art" by the 2002 AAP Technical Report on the Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome [37] is another major advance that sets the stage for the next steps. The field needs an evidence-based definitions conference, standardization of definitions across all research studies, and much more research on clinical features, pathophysiology, diagnosis, and treatment of the "new" obstructive SDB, including the full range of morbidity caused by increased upper airway resistance. This should include further inquiry into the origins of adult morbidity that resulted from childhood SDB and how it can be prevented.