Current understanding of the role of sleep-disordered breathing in pediatric pulmonary hypertension

Background: Sleep-disordered breathing is a potentially reversible cause of pulmonary hypertension. Addition-ally, sleep-disordered breathing importantly contributes to disease severity in individuals with all causes of pulmonary hypertension. The co-existence of pulmonary hypertension and sleep-disordered breathing must be recognized as it may alter treatment strategies.Aim of review: Here, we aim to describe the overlap between sleep-disordered breathing and pulmonary hy-pertension with a focus on infants and children. We will review the available literature regarding the prevalence of co-occurrence, the described pathophysiology, as well as the presentation, diagnosis, and management con-siderations for sleep-disordered breathing in the setting of pulmonary hypertension.Key scientific concepts of review:1. Pulmonary hypertension is a described complication of sleep-disordered breathing, though the prevalence of co-occurrence in children is not well studied.2. Apneas and hypopneas cause rapid pleural pressure changes, hypoxia, and sympathetic nerve activation that lead to increased mean pulmonary artery pressure.3. Obstructive sleep apnea must be identified and treated aggressively if pulmonary hypertension is present.