{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:11:40Z","timestamp":1784549500881,"version":"3.55.0"},"reference-count":73,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T00:00:00Z","timestamp":1740441600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Sleep-disordered breathing (SDB) is a primary concern in children\u2019s health. Research suggests that repeated oxygen drops during sleep\u2014common in SDB\u2014may harm the brainstem\u2019s breathing control centres. This damage likely occurs through oxidative stress, inflammation, and cell death, which weaken the brain\u2019s ability to regulate breathing. Over time, these effects could lead to functional changes (e.g., disrupted chemical signalling) and physical damage in critical brain regions, creating a cycle of unstable breathing. However, much of this evidence comes from animal or lab studies, leaving gaps in our understanding of how these mechanisms work in humans. This review synthesises existing research on how breathing disruptions during sleep\u2014particularly episodes of intermittent hypoxia\u2014affect the brain\u2019s ability to control respiration in children and adolescents. Methods: We analysed studies from medical databases PubMed, Scopus, and Web of Science, focusing on how SDB (obstructive or central sleep apnoea) impacts the brain\u2019s respiratory centres in young populations. Animal studies and research involving children on mechanical ventilation were excluded to focus on natural sleep patterns. Results: After removing duplicates, 54 studies remained. Additionally, 43 record were excluded for various reasons. Ultimately, 11 articles were selected for the final analysis, including three that focused on genetic conditions, such as Down syndrome, Prader\u2013Willi syndrome, and Pierre Robin sequence. The findings suggest that repeated oxygen dips during sleep may harm the brainstem\u2019s respiratory control areas, especially during critical developmental stages. This damage could lead to long-term issues, such as unstable breathing, cardiovascular strain, or neurological problems. However, most studies only captured the immediate effects of low oxygen, leaving uncertainty about permanent harm due to a lack of long-term follow-up. Conclusions: Repeated oxygen deprivation during sleep appears to damage the brainstem and disrupt breathing regulation. However, small study sizes and short observation periods limit the strength of these conclusions. Future research should use advanced imaging tools to clarify long-term risks, develop effective treatments, and track children over extended periods. More significantly, longer-term studies are urgently needed to guide clinical care for vulnerable populations.<\/jats:p>","DOI":"10.3390\/children12030279","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T06:13:18Z","timestamp":1740463998000},"page":"279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Sleep-Disordered Breathing and Central Respiratory Control in Children: A Comprehensive Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8659-5505","authenticated-orcid":false,"given":"Marco","family":"Zaffanello","sequence":"first","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9912-3232","authenticated-orcid":false,"given":"Angelo","family":"Pietrobelli","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5453-724X","authenticated-orcid":false,"given":"Luana","family":"Nosetti","sequence":"additional","affiliation":[{"name":"Lombardy Regional SIDS Center, Division of Pediatrics, F. Del Ponte Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9917-2387","authenticated-orcid":false,"given":"Giuliana","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Rigotti","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Ganzarolli","sequence":"additional","affiliation":[{"name":"Pediatric Division, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Piacentini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Nosetti, L., Zaffanello, M., Simoncini, D., Dellea, G., Vitali, M., Amoudi, H., and Agosti, M. (2024). Prioritising Polysomnography in Children with Suspected Obstructive Sleep Apnoea: Key Roles of Symptom Onset and Sleep Questionnaire Scores. Children, 11.","DOI":"10.20944\/preprints202409.1034.v1"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lajoie, A.C., Lafontaine, A.L., Kimoff, R.J., and Kaminska, M. (2020). Obstructive Sleep Apnea in Neurodegenerative Disorders: Current Evidence in Support of Benefit from Sleep Apnea Treatment. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020297"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1111\/j.1469-8749.1999.tb00656.x","article-title":"Apneustic breathing in children with brainstem damage due to hypoxic-ischemic encephalopathy","volume":"41","author":"Saito","year":"1999","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1017\/S0317167100004157","article-title":"Canadian Association of Neuroscience Review: Respiratory control and behavior in humans: Lessons from imaging and experiments of nature","volume":"32","author":"Moss","year":"2005","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"44566","DOI":"10.1038\/srep44566","article-title":"Reduced Regional Grey Matter Volumes in Pediatric Obstructive Sleep Apnea","volume":"7","author":"Philby","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1152\/japplphysiol.00194.2017","article-title":"On the existence of a central respiratory oxygen sensor","volume":"123","author":"Gourine","year":"2017","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/(SICI)1099-0496(199611)22:5<287::AID-PPUL1>3.0.CO;2-I","article-title":"The biphasic ventilatory response to hypoxia in preterm infants is not due to a decrease in metabolism","volume":"22","author":"Rehan","year":"1996","journal-title":"Pediatr. Pulmonol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"974643","DOI":"10.3389\/fped.2022.974643","article-title":"The ventilatory response to hypoxia is blunted in some preterm infants during the second year of life","volume":"10","author":"Freislich","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"609","DOI":"10.3389\/fphys.2016.00609","article-title":"Key Brainstem Structures Activated during Hypoxic Exposure in One-day-old Mice Highlight Characteristics for Modeling Breathing Network in Premature Infants","volume":"7","author":"Joubert","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Zaffanello, M., Ersu, R.H., Nosetti, L., Beretta, G., Agosti, M., and Piacentini, G. (2024). Cardiac Implications of Adenotonsillar Hypertrophy and Obstructive Sleep Apnea in Pediatric Patients: A Comprehensive Systematic Review. Children, 11.","DOI":"10.3390\/children11020208"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zaffanello, M., Ferrante, G., Zoccante, L., Ciceri, M.L., Nosetti, L., Tenero, L., Piazza, M., and Piacentini, G. (2023). Predictive Power of Oxygen Desaturation Index (ODI) and Apnea-Hypopnea Index (AHI) in Detecting Long-Term Neurocognitive and Psychosocial Outcomes of Sleep-Disordered Breathing in Children: A Questionnaire-Based Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12093060"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e2222999","DOI":"10.1001\/jamanetworkopen.2022.22999","article-title":"Association of Obstructive Sleep Apnea with White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood","volume":"5","author":"Lee","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_13","first-page":"967","article-title":"Brain structural changes in obstructive sleep apnea","volume":"31","author":"Macey","year":"2008","journal-title":"Sleep"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"105782","DOI":"10.1016\/j.neubiorev.2024.105782","article-title":"Cognitive and brain morphological deviations in middle-to-old aged autistic adults: A systematic review and meta-analysis","volume":"163","author":"Wang","year":"2024","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.resp.2018.07.003","article-title":"The role of the hypothalamus in modulation of respiration","volume":"265","author":"Fukushi","year":"2019","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.4103\/0970-2113.56345","article-title":"Sleep effects on breathing and respiratory diseases","volume":"26","author":"Choudhary","year":"2009","journal-title":"Lung India"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1007\/s11325-020-02175-1","article-title":"Obstructive sleep apnea and respiratory center regulation abnormality","volume":"25","author":"Si","year":"2021","journal-title":"Sleep. Breath."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1139\/y03-049","article-title":"Adaptation in the respiratory control system","volume":"81","author":"Duffin","year":"2003","journal-title":"Can. J. Physiol. Pharmacol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"zsz044","DOI":"10.1093\/sleep\/zsz044","article-title":"The impact of central and obstructive respiratory events on cerebral oxygenation in children with sleep disordered breathing","volume":"42","author":"Tamanyan","year":"2019","journal-title":"Sleep"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"zsx120","DOI":"10.1093\/sleep\/zsx120","article-title":"The Impact of Altitude on Sleep-Disordered Breathing in Children Dwelling at High Altitude: A Crossover Study","volume":"40","author":"Hughes","year":"2017","journal-title":"Sleep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S103","DOI":"10.14639\/0392-100X-suppl.1-43-2023-13","article-title":"Treatment of sleep disordered breathing relapse after surgery","volume":"43","author":"Vicini","year":"2023","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.resp.2013.04.021","article-title":"Sleep-disordered breathing: Effects on brain structure and function","volume":"188","author":"Harper","year":"2013","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1055\/s-0029-1237122","article-title":"Neurologic aspects of sleep apnea: Is obstructive sleep apnea a neurologic disorder?","volume":"29","author":"Guilleminault","year":"2009","journal-title":"Semin. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/0165-3806(86)90280-4","article-title":"Prenatal and postnatal maturation of medullary \u2018respiratory centers\u2019","volume":"391","author":"Takashima","year":"1986","journal-title":"Brain Res."},{"key":"ref_26","first-page":"95","article-title":"Transcutaneous monitoring as trigger for therapy of hypoxemia during sleep","volume":"220","author":"Schlaefke","year":"1987","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1542\/peds.97.4.554","article-title":"Respiratory characteristics during sleep in healthy small-for- gestational age newborns","volume":"97","author":"Peirano","year":"1996","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.physbeh.2004.06.011","article-title":"Central respiratory pauses, sighs, and gross body movements during sleep in children","volume":"82","author":"Fukumizu","year":"2004","journal-title":"Physiol. Behav."},{"key":"ref_29","first-page":"2579","article-title":"Detection of central respiratory events using pulse transit time in infants","volume":"2005","author":"Foo","year":"2005","journal-title":"Conf. Proc. IEEE Eng. Med. Biol. Soc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1243\/09544119JEIM395","article-title":"Use of the pulse transit time trend to relate tidal breathing and central respiratory events","volume":"222","author":"Foo","year":"2008","journal-title":"Proc. Inst. Mech. Eng. H"},{"key":"ref_31","first-page":"65","article-title":"Respiratory control in children with Prader-Willi syndrome","volume":"156","author":"Buschatz","year":"1997","journal-title":"Eur. J. Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1046\/j.1365-2869.1997.00030.x","article-title":"Respiratory patterns during sleep in Down\u2019s syndrome:importance of central apnoeas","volume":"6","author":"Ferri","year":"1997","journal-title":"J. Sleep Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/S0378-3782(00)00073-6","article-title":"Neurophysiological brainstem investigations in isolated Pierre Robin sequence","volume":"58","author":"Renault","year":"2000","journal-title":"Early Hum. Dev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2390","DOI":"10.1001\/jama.2012.94847","article-title":"Effect of acetazolamide and autoCPAP therapy on breathing disturbances among patients with obstructive sleep apnea syndrome who travel to altitude: A randomised controlled trial","volume":"308","author":"Latshang","year":"2012","journal-title":"JAMA"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1046\/j.1365-2869.1998.00111.x","article-title":"Heart rate variability and apnea during sleep in Down\u2019s syndrome","volume":"7","author":"Ferri","year":"1998","journal-title":"J. Sleep Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1113\/jphysiol.2005.095968","article-title":"On the peripheral and central chemoreception and control of breathing: An emerging role of ATP","volume":"568","author":"Gourine","year":"2005","journal-title":"J. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.2147\/NSS.S489232","article-title":"Impact of Chronic Intermittent Hypoxia on Cognitive Function and Hippocampal Neurons in Mice: A Study of Inflammatory and Oxidative Stress Pathways","volume":"16","author":"Zhang","year":"2024","journal-title":"Nat. Sci. Sleep"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3389\/fncir.2013.00016","article-title":"Control of breathing by interacting pontine and pulmonary feedback loops","volume":"7","author":"Molkov","year":"2013","journal-title":"Front. Neural Circuits"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1113\/EP091206","article-title":"Hypoxia sensing in the body: An update on the peripheral and central mechanisms","volume":"109","author":"Zoccal","year":"2024","journal-title":"Exp. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1177\/0194599812473412","article-title":"Weight gain after adenotonsillectomy is more common in young children","volume":"148","author":"Smith","year":"2013","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.heares.2015.11.014","article-title":"Modulation of auditory brainstem responses by serotonin and specific serotonin receptors","volume":"332","author":"Papesh","year":"2016","journal-title":"Hear. Res."},{"key":"ref_42","first-page":"73","article-title":"Acute and chronic hypoxia: Implications for cerebral function and exercise tolerance","volume":"2","author":"Goodall","year":"2014","journal-title":"Fatigue"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.7150\/ijms.86622","article-title":"Intermittent Hypoxia Conditioning: A Potential Multi-Organ Protective Therapeutic Strategy","volume":"20","author":"Zhang","year":"2023","journal-title":"Int. J. Med. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"893","DOI":"10.3389\/fphys.2018.00893","article-title":"Contribution of Oxidative Stress and Inflammation to the Neurogenic Hypertension Induced by Intermittent Hypoxia","volume":"9","author":"Oyarce","year":"2018","journal-title":"Front. Physiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1542\/peds.2012-1671","article-title":"Diagnosis and management of childhood obstructive sleep apnea syndrome","volume":"130","author":"Marcus","year":"2012","journal-title":"Pediatrics"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1038\/s41392-023-01496-3","article-title":"Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome","volume":"8","author":"Lv","year":"2023","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1046166","DOI":"10.3389\/fphys.2022.1046166","article-title":"Sleep loss effects on physiological and cognitive responses to systemic environmental hypoxia","volume":"13","author":"Fabries","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1090547","DOI":"10.3389\/fnagi.2023.1090547","article-title":"The complex interplay of hypoxia and sleep disturbance in gray matter structure alterations in obstructive sleep apnea patients","volume":"15","author":"Wang","year":"2023","journal-title":"Front. Aging Neurosci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"F1000-Faculty","DOI":"10.12688\/f1000research.18358.1","article-title":"Central sleep apnea: Misunderstood and mistreated!","volume":"8","author":"Dempsey","year":"2019","journal-title":"F1000Res"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1152\/jn.00608.2015","article-title":"Functional connectivity in raph\u00e9-pontomedullary circuits supports active suppression of breathing during hypocapnic apnea","volume":"114","author":"Nuding","year":"2015","journal-title":"J. Neurophysiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.resp.2004.03.020","article-title":"Modeling the ponto-medullary respiratory network","volume":"143","author":"Rybak","year":"2004","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ejpn.2003.12.005","article-title":"Watershed infarcts in the fetal and neonatal brainstem. An aetiology of central hypoventilation, dysphagia, M\u00f6ibius syndrome and micrognathia","volume":"8","author":"Sarnat","year":"2004","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1164\/rccm.200201-050OC","article-title":"Brain morphology associated with obstructive sleep apnea","volume":"166","author":"Macey","year":"2002","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"426","DOI":"10.23736\/S2724-5276.17.04965-9","article-title":"The impact of intrauterine growth restriction on respiratory outcomes","volume":"73","author":"Oliveira","year":"2021","journal-title":"Minerva Pediatr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1111\/j.1469-7610.2008.01918.x","article-title":"A neurobiological model for the effects of early brainstem functioning on the development of behavior and emotion regulation in infants: Implications for prenatal and perinatal risk","volume":"49","author":"Geva","year":"2008","journal-title":"J. Child. Psychol. Psychiatry"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1093\/scan\/nsr082","article-title":"Neonatal brainstem dysfunction risks infant social engagement","volume":"8","author":"Geva","year":"2013","journal-title":"Soc. Cogn. Affect. Neurosci."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Oros, M., Baranga, L., Plaiasu, V., Cozma, S.R., Neagos, A., Paduraru, L., Necula, V., Martu, C., Dima-Cozma, L.C., and Gheorghe, D.C. (2021). Obstructing Sleep Apnea in Children with Genetic Disorders-A Special Need for Early Multidisciplinary Diagnosis and Treatment. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102156"},{"key":"ref_58","first-page":"243","article-title":"The sympathetic nervous system and catecholamines metabolism in obstructive sleep apnoea","volume":"8","author":"Bisogni","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_59","first-page":"1077","article-title":"Intermittent hypoxia from obstructive sleep apnea may cause neuronal impairment and dysfunction in central nervous system: The potential roles played by microglia","volume":"9","author":"Yang","year":"2013","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"5042","DOI":"10.1172\/JCI137560","article-title":"Hypoxia-inducible factors and obstructive sleep apnea","volume":"130","author":"Prabhakar","year":"2020","journal-title":"J. Clin. Invest."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1414","DOI":"10.1164\/rccm.200411-1564OC","article-title":"Inducible nitric oxide synthase in long-term intermittent hypoxia: Hypersomnolence and brain injury","volume":"171","author":"Zhan","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3389\/fnins.2016.00004","article-title":"Chronic Intermittent Hypoxia Alters Local Respiratory Circuit Function at the Level of the preB\u00f6tzinger Complex","volume":"10","author":"Garcia","year":"2016","journal-title":"Front. Neurosci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s00787-015-0740-2","article-title":"Identifying features of \u2018pathological demand avoidance\u2019 using the Diagnostic Interview for Social and Communication Disorders (DISCO)","volume":"25","author":"Gould","year":"2016","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.neuroscience.2004.03.055","article-title":"Increased oxidative stress is associated with chronic intermittent hypoxia-mediated brain cortical neuronal cell apoptosis in a mouse model of sleep apnea","volume":"126","author":"Xu","year":"2004","journal-title":"Neuroscience"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.neulet.2004.10.091","article-title":"Intermittent hypoxia damages cerebellar cortex and deep nuclei","volume":"375","author":"Pae","year":"2005","journal-title":"Neurosci. Lett."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/aps.2011.184","article-title":"Chronic intermittent hypoxia-induced deficits in synaptic plasticity and neurocognitive functions: A role for brain-derived neurotrophic factor","volume":"33","author":"Xie","year":"2012","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"824","DOI":"10.3892\/mmr.2021.12464","article-title":"Intermittent hypoxia mimicking obstructive sleep apnea aggravates early brain injury following ICH via neuroinflammation and apoptosis","volume":"24","author":"Fei","year":"2021","journal-title":"Mol. Med. Rep."},{"key":"ref_68","first-page":"7","article-title":"The effect of environmental lighting on the oxygen saturation of preterm infants in the NICU","volume":"12","author":"Shogan","year":"1993","journal-title":"Neonatal Netw."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1152\/jappl.1992.73.4.1558","article-title":"A respiratory sensory reflex in response to CO2 inhibits breathing in preterm infants","volume":"73","author":"Alvaro","year":"1992","journal-title":"J. Appl. Physiol. (1985)"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"81","DOI":"10.5409\/wjcp.v4.i4.81","article-title":"Caffeine therapy in preterm infants","volume":"4","author":"Nasef","year":"2015","journal-title":"World J. Clin. Pediatr."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1002\/ppul.23177","article-title":"Sleep disordered breathing in patients with Prader-Willi syndrome: A multicenter study","volume":"50","author":"Pavone","year":"2015","journal-title":"Pediatr. Pulmonol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Betavani, V.M.P., Davey, M.J., Nixon, G.M., Walter, L.M., and Horne, R.S.C. (2022). Effects of Treatment of Sleep Disordered Breathing on Sleep Macro- and Micro-Architecture in Children with Down Syndrome. Children, 9.","DOI":"10.3390\/children9070984"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1016\/S2213-2600(16)30151-5","article-title":"Long-term non-invasive ventilation in children","volume":"4","author":"Amaddeo","year":"2016","journal-title":"Lancet Respir. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/3\/279\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:42:05Z","timestamp":1760028125000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/3\/279"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,25]]},"references-count":73,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["children12030279"],"URL":"https:\/\/doi.org\/10.3390\/children12030279","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,25]]}}}