Current and Emerging Therapies for Pediatric Sleep Disorders: A Narrative Review

Sleep disorders in children represent a significant public health concern with important implications for neurodevelopment, behavior, and overall health. Among these, pediatric obstructive sleep apnea (OSA), insomnia, narcolepsy, and sleep-related movement disorders are the most clinically relevant conditions requiring targeted therapeutic strategies. Pediatric OSA, affecting approximately 2-5% of children, is characterized by recurrent upper airway obstruction during sleep and is associated with cognitive, behavioral, and cardiovascular consequences. Management is multimodal, with adenotonsillectomy as first-line therapy, which improves most patients, although residual disease remains common. Adjunctive treatments include anti-inflammatory therapies such as intranasal corticosteroids and leukotriene receptor antagonists, positive airway pressure therapy, and emerging approaches such as high-flow nasal cannula, drug-induced sleep endoscopy-guided surgery, orthodontic interventions, and hypoglossal nerve stimulation in selected populations. Insomnia in children is primarily managed with behavioral interventions, particularly cognitive behavioral therapy for insomnia (CBT-I) and parental education strategies. Melatonin has demonstrated modest efficacy in reducing sleep latency, especially in children with neurodevelopmental disorders, although long-term safety data remain limited. Narcolepsy requires a combination of behavioral and pharmacological management, with scheduled naps as first-line therapy and medications such as stimulants, sodium oxybate, and pitolisant targeting excessive daytime sleepiness and cataplexy. Sleep-related movement disorders, including restless legs syndrome and periodic limb movement disorder, are frequently associated with iron deficiency and are primarily treated with iron supplementation alongside behavioral strategies. Overall, the treatment of pediatric sleep disorders requires a multidisciplinary, individualized approach that integrates behavioral, pharmacologic, and interventional therapies. Advances in precision medicine, device-based treatments, and targeted interventions are expanding the therapeutic landscape, emphasizing the importance of early recognition and tailored management to improve long-term outcomes in children.