Table 2.

Consequences of OSA in children.

Author (Year)	Number of Participants	Age (Years)	OSA Severity Criteria	Outcomes	Results
Behavioral and neurocognitive sphere
Menzies et al., 2022 [38] Metanalysis of 63 studies	17,834	From 2 to 18 years	Due to the lack of a consensus severity criterion, the subgroup given by the author was used (e.g., mild OSA)	Intelligence, attention, memory, visual spatial skills, and language	Children with SDB had significant impairments in all cognitive domains, intelligence being the most-affected quality. These neurocognitive deficits were found in primary snorers among OSA children.
Growth retardation and metabolism
Lagravère et al., 2019 [39] Systematic review of 12 studies				Growth mediators (IGF-I and IGFBP-3)	Children with OSA present lower levels of growth mediators, indicating growth retardation, significantly higher cardiovascular disease risk, and decreased cognitive functions compared to healthy controls. Tonsillectomy may improve all these functions with a great impact on general health.
Cardiovascular sphere
Ai et al., 2022 [40] Metanalysis of 14 studies	3081	3 to 17 years	Mild OSA is defined as an AHI between 1 and 5 events per hour Moderate to severe is defined as an AHI ≥ 5 /h.	BP parameters: awake and nighttime SBP and DBP	The mean SBP was higher in children with mild or moderate-to-severe OSA compared to healthy controls, these effects being more pronounced during the night. The results suggest that moderate-to-severe OSA in children is associated with a higher risk of adverse SBP outcomes.

Abbreviations: OSA: obstructive sleep apnea; SDB: sleep-disordered breathing; IGF-1: insulin-like growth factor 1; IGFBP3: insulin-like growth factor-binding protein 3; AHI: apnea/hypopnea index; BP: blood pressure; SBP: systolic blood pressure; DBP: diastolic blood pressure.