Children with a cleft palate and/or velopharyngeal dysfunction, with or without other craniofacial abnormalities, may present with disordered breathing during sleep, ranging from uncomplicated primary snoring to very severe obstructive sleep apnea syndrome (OSAS) with dramatic oxygen desaturation, hypoventilation, and daytime symptoms. These patients are also at an increased risk of developing OSA after surgical procedures are performed to improve their speech. Physicians caring for these children should understand the unique anatomic and physiologic challenges that the upper airway of these patients can present. The gold standard for the detection of sleep-disordered breathing remains overnight, attended, laboratory polysomnography because it provides an objective, quantitative evaluation of disturbances in both respiratory and sleep parameters. The treatment of sleep-disordered breathing in these patients may include surgical procedures or continuous positive airway pressure.