Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing consisting of upper airway collapse during sleep that results in repetitive arousals and desaturations. Estimates of disease prevalence range between 1% and 3% of the general pediatric population, with significant associated clinical consequences on individual morbidity. Consequences of untreated pediatric OSA include metabolic, endocrine, cardiovascular, and neurobehavioral implications with potential for long-term consequences. However, many pathogenic features of this syndrome in children remain unclear. Understanding principal mechanisms of OSA is critical for ultimately allowing for the development of therapeutic strategies. Much of the pathogenic mechanisms of OSA currently center around upper airway collapsibility.