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)
 Symptoms reflecting upper airway obstruction are frequently present both during wakefulness and sleepYesNo
 Adenotonsillar hypertrophy and obesity predominantly cause SDBNoYes
 Various congenital, syndromic and/or genetic entities predominantly cause SDBYesNo
 Feeding difficulties and growth failure may coexist with OSASYesNo
 Pulmonary hypertension may complicate OSAS, especially in patients with complex conditionsYesYes
 Polysomnography is the gold standard for diagnosis of OSASYesYes
 Endoscopy is especially useful to determine the level of upper airway collapseYesNo
 Adenotonsillectomy is the most commonly used treatmentNoYes
 NPPV is frequently used as first-line treatment due to a high incidence of multilevel, dynamic airway collapseYesNo
 Orthodontic appliances are effective in cases of OSAS with retrognathia or malocclusionNoYes
 Patients with complex conditions are prioritised for treatmentYesYes
 Follow-up after each treatment intervention may identify persistent OSASYesYes
 Patients on NPPV undergo nocturnal cardiorespiratory monitoring annuallyYesYes

OSAS: obstructive sleep apnoea syndrome; NPPV: non-invasive positive pressure ventilation.