title: The multiple challenges of obstructive sleep apnea in children: diagnosis.
abstract: OBJECTIVE
  To review some of the inherent problems in defining the diagnosis of pediatric obstructive sleep apnea (OSA) and propose a novel approach to clinical evaluation and referral of habitually snoring children.
  
  
  RESULTS
  OSA has emerged in the last 30 years as a highly prevalent condition in children. However, the diagnostic uncertainties associated with the clinical presentation and physical examination, and changes in the clinical phenotype over time dictated by the escalation of obesity in children, along with the objective difficulties in accessing appropriately equipped sleep laboratories, have led to substantial underrecognition and to implementation of empirically driven treatment interventions for which scientific validity and efficacy remain undefined.
  
  
  CONCLUSIONS
  Current tools for the diagnosis of OSA in children are labor-intensive, and onerous, and remain unvalidated. Novel diagnostic approaches linking objective physiological, biological, or both, measures to defined outcomes of pediatric OSA need to be developed and validated to enable wider and earlier recognition of this condition.
authors.affiliation: Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.
authors.forename: Leila
authors.initials: L
authors.lastname: Kheirandish-Gozal
authors.forename: David
authors.initials: D
authors.lastname: Gozal
mesh_terms: D002648:Child; D006801:Humans; D010092:Oximetry / Q000379:methods; D010808:Physical Examination / Q000379:methods; D017286:Polysomnography / Q000379:methods*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*