Similarities and differences in the diagnosis and management of obstructive sleep disordered breathing (SDB) in younger and older children (1–23 months versus 2–18 years)
| Younger children (1– 23 months) | Older children (2–18 years) | |
| Diagnosis | ||
| Symptoms reflecting upper airway obstruction are frequently present both during wakefulness and sleep | Yes | No |
| Adenotonsillar hypertrophy and obesity predominantly cause SDB | No | Yes |
| Various congenital, syndromic and/or genetic entities predominantly cause SDB | Yes | No |
| Feeding difficulties and growth failure may coexist with OSAS | Yes | No |
| Pulmonary hypertension may complicate OSAS, especially in patients with complex conditions | Yes | Yes |
| Polysomnography is the gold standard for diagnosis of OSAS | Yes | Yes |
| Endoscopy is especially useful to determine the level of upper airway collapse | Yes | No |
| Management | ||
| Adenotonsillectomy is the most commonly used treatment | No | Yes |
| NPPV is frequently used as first-line treatment due to a high incidence of multilevel, dynamic airway collapse | Yes | No |
| Orthodontic appliances are effective in cases of OSAS with retrognathia or malocclusion | No | Yes |
| Patients with complex conditions are prioritised for treatment | Yes | Yes |
| Follow-up after each treatment intervention may identify persistent OSAS | Yes | Yes |
| Patients on NPPV undergo nocturnal cardiorespiratory monitoring annually | Yes | Yes |
OSAS: obstructive sleep apnoea syndrome; NPPV: non-invasive positive pressure ventilation.