A comprehensive review of sleep disordered breathing in people with congenital heart disease.

INTRODUCTION: Sleep disordered breathing (SDB) is known to be a comorbidity associated with congenital heart disease (CHD). This review evaluates the role of sleep disorders as a contributing factor to impairments in cardiovascular health, neurocognitive function, and health-related quality of life in individuals with CHD. METHODS: A narrative review was conducted across PubMed, Ovid, and Cochrane Library (1990-2025) searches for studies cross-referencing "congenital heart disease" or "Fontan circulation" with sleep-related terms. Inclusion criteria were studies in CHD populations using objective or self-report sleep assessments; exclusions included non-English, non-original data, or conference abstracts. References of included articles were also screened to identify additional potentially relevant articles. Thirty three of 523 articles screened met inclusion criteria. RESULTS: SDB is prevalent in both children and adults with CHD, with reported rates ranging from 31 to 63% in adults and up to 57% in children. Both obstructive and central sleep apnea are observed. Comorbid SDB is associated with increased inpatient mortality in infants, poorer quality of life in children and adults, neurocognitive impairments, and increased cardiovascular risk including arrhythmias and paradoxical emboli. Evidence for effective treatment remains limited, though lifestyle, behavioral, and ventilation strategies show potential benefit. DISCUSSION: SDB is common in both children and adults with CHD and has a negative association with behavior, cognition and quality of life for people with CHD.