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The definition of OSAS in the first 2\u2005years of life should probably differ from that applied in children older than 2\u2005years. An obstructive apnoea\u2013hypopnoea index &gt;5\u2005events\u00b7h<jats:sup>\u22121<\/jats:sup>may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12\u2005months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2\u2005years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.<\/jats:p>","DOI":"10.1183\/16000617.0121-2023","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T09:30:13Z","timestamp":1706693413000},"page":"230121","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["An update on diagnosis and management of obstructive sleep apnoea in the first 2\u2005years of life"],"prefix":"10.1183","volume":"33","author":[{"given":"Anastasia","family":"Polytarchou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angeliki","family":"Moudaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eli","family":"Van de Perck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An","family":"Boudewyns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3592-0037","authenticated-orcid":false,"given":"Athanasios G.","family":"Kaditis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stijn","family":"Verhulst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refika","family":"Ersu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"2024102404173838000_33.171.230121.1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00985-2017"},{"key":"2024102404173838000_33.171.230121.2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00385-2015"},{"key":"2024102404173838000_33.171.230121.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2011.05.006"},{"key":"2024102404173838000_33.171.230121.4","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1002\/lary.29784","article-title":"Improvement in central sleep apnea following adenotonsillectomy in children","volume":"132","author":"Judd","year":"2022","journal-title":"Laryngoscope"},{"key":"2024102404173838000_33.171.230121.5","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1542\/peds.60.4.418","article-title":"Polygraphic studies of normal infants during the first six months of life: III. 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