What is "abnormal" in pediatric sleep?

Sleep-disordered breathing in general and, more particularly, the obstructive sleep apnea syndrome are highly prevalent conditions in children. Although the diagnosis appears relatively straightforward using a sleep study (polysomnography), this labor-intensive and expensive procedure is used in only a minority of cases across the country because of the relative unavailability of pediatric sleep centers. However, the definition of an abnormal sleep study is not a trivial process and requires a methodical delineation of normative data, implication of "abnormal" variables to specific outcomes, and demonstration of cost-effectiveness of such approach. Unfortunately, such studies are lacking; there is no real consensus on any of these important aspects, which in turn leads to delays in diagnosis and treatment. Such paucity of validated data, however, is an opportunity to explore alternative options that would enable incorporation of biomarkers into well defined and validated algorithms. There is no doubt that novel approaches to the evaluation of community-based and clinically referred pediatric populations should enable more pragmatic and reliable diagnostic approaches for pediatric sleep-disordered breathing.