OBJECTIVES: To describe the sleep architecture of pediatric patients according to whether they were born low birthweight (birthweight <2500 g, LBW) or normal birthweight (birthweight >2500 g). DESIGN: Case control study. SETTING: Pediatric sleep laboratory in the Northern Territory of Australia during a 5-year study period (2015- 2020). PARTICIPANTS: Pediatric patients (aged <18 years) referred to the specialist sleep service for assessment of clinically suspected sleep disorders. MEASUREMENTS: Sleep onset latency, rapid eye movement (REM) sleep latency, wake time after sleep onset, total sleep time, sleep efficiency, non-rapid eye movement stages N1/N2/N3, and REM sleep duration, total/spontaneous/respiratory/limb related arousal indexes, total/non-rapid eye movement/REM obstructive apnea-hypopnea index and oxygen saturation. RESULTS: One hundred and seventy-two pediatric patients had birthweight data available of whom 19 were LBW. LBW patients showed significantly greater sleep disruption and higher prevalence of poor sleepers (<80% efficiency). In multivariate regression models, increasing birthweight was associated with significantly greater sleep efficiency and total sleep time. After accounting for gestational age LBW was associated with increased odds of obstructive sleep apnea. CONCLUSIONS: Among pediatric patients LBW is associated with increased sleep disruption and reduced sleep efficiency. This is attenuated by gestational age, though both gestational age and LBW significantly influence odds of obstructive sleep apnea. This sleep health deficit may contribute to development of chronic disease in this vulnerable population, and should be monitored to provide avenues for early intervention.