Prematurity and obstructive sleep apnea in children: The perfect storm

As survival rates for premature infants improve, understanding the link between prematurity and obstructive sleep apnea (OSA) has become critical for enhancing outcomes in this high-risk population. Children born severely prematurely face a threefold increased risk of developing OSA due to anatomical and physiological factors, such as an abnormal upper airway, unstable ventilatory control, bronchopulmonary dysplasia, and increased susceptibility to respiratory infections. The multisystemic impact of prematurity also increases the likelihood of adverse OSA outcomes, such as neurodevelopmental deficits and pulmonary hypertension, generating a “Perfect Storm” for children affected by both conditions. Here, we summarize new insights into the shared pathophysiological mechanisms linking prematurity and OSA, highlighting the need to identify and characterize OSA in all premature infants. Polysomnographic assessments of sleep-disordered breathing and ventilatory responses to hypoxia/hyperoxia may enable tailored oxygen saturation targets for supplementation and weaning, based on each infant's unique physiology rather than relying on generalized protocols.