Aim: Home sleep testing is becoming more common in the diagnostics of pediatric obstructive sleep apnea. The aim was to examine the agreement between manual and automatic analyses of home sleep examinations in children and adolescents. Materials & methods: Sleep examinations recorded with a type 3 sleep monitor (Nox T3) were analyzed manually by a registered polysomnographic technologist and automatically with Noxturnal version 5.1. Results: 51sleep examinations on children and adolescents with a median age of 13.6 years were included. The median manual apnea-hypopnea index (AHI) was 2.7 (range 0.2 to 28.2), while the median automatic AHI was 11.9 (range 4.2 to 45.6; p < 0.001). Conclusion: The agreement between manual and automatic analyses was poor. The AHI was consistently overestimated by automatic analysis.