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

Sleep-disordered breathing is a potentially reversible cause of pulmonary hypertension. Additionally, 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. Here, we aim to describe the overlap between sleep-disordered breathing and pulmonary hypertension 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 considerations for sleep-disordered breathing in the setting of pulmonary hypertension. 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. •Isolated sleep disordered breathing can cause pulmonary hypertension.•Pulmonary hypertension can be worsened by sleep disordered breathing.•Polysomnogram is part of comprehensive work-up in pulmonary hypertension.•Pulmonary hypertension due to sleep disordered breathing is often reversible.•Sleep disordered breathing should be treated if pulmonary hypertension coexists.