Sleep and metabolism are intimately linked, and sleep deprivation has a strong link to obesity. Obesity is also a known risk factor for obstructive sleep apnoea (OSA), which causes both sleep deprivation and exposure to intermittent hypoxia. The high incidence of sleep disorders amongst children with obesity means that all children presenting for weight management should be asked about their sleep habits, and symptoms of OSA (snoring, witnessed apnoea, daytime sleepiness). Studies demonstrate that links between obesity and sleep problems emerge during childhood, with OSA shown to have additional association with risks for cardiovascular disease including insulin resistance and poor cardiac response to stressors such as exercise. Management of the sleep issue can reverse the sequelae. While adenotonsillectomy may be the preferred treatment, anaesthetic risk for these children is increased, and adenotonsillectomy has lower treatment success in this population so CPAP (continuous positive airways pressure) is often the only adequate treatment although compliance has been a major barrier to the successful treatment of these children. Management of sleep hygiene has also been linked to improved weight loss. Consultation with a sleep physician and sleep studies may significantly improve the health outcomes for these children.