Obstructive sleep apnea syndrome (OSAS) is a common, under-recognized condition in childhood with significant morbidities if undiagnosed and untreated. The American Academy of Pediatrics recently issued a clinical practice guideline for the diagnosis and management of childhood OSAS. It was accompanied by a comprehensive evidence-based technical report that summarized the available literature supporting the guideline. The current review highlights areas of controversy and uncertainty that limit the development of more definitive standards of practice, updates the reader to several newer publications relevant to diagnosis and treatment of childhood OSAS, and identifies future directions for clinical research.