Why kids with Down syndrome are at high risk for obstructive sleep apnea

In 2011, the American Academy of Pediatrics published updated guidelines regarding the medical care for children with Down syndrome. It was recommended that all children with Down syndrome should have a sleep study by age 4. Why?

Children with Down syndrome are at high risk for obstructive sleep apnea or OSA. OSA is a sleep disorder in which the upper airway periodically closes off, not allowing airflow, until the airway reopens with a gasp or snort. This can happen a few times to many times throughout the night.

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OSA results in disrupted sleep and may also cause low oxygen levels during sleep. It is estimated that 50-75% of those with Down syndrome will develop OSA.

Reasons for the increased risk of obstructive sleep apnea in Down syndrome

There are various reasons for this increased risk for OSA in Down syndrome. These include:

1. Large tongue relative to size of mouth: The tongue can fall back into the throat when they lie on their back, obstructing the airway.
2. Low muscle tone: The muscles and tissues of the upper airway are more relaxed during sleep and do not keep the airway open as well.
3. Risk for obesity: Obesity, in general, is a risk factor for OSA.
4. Large tonsils and adenoid tissue: Just like children without Down syndrome, these tissues can block the upper airway and cause OSA.

Diagnosing and treating obstructive sleep apnea in children with Down syndrome

In general, OSA causes poor sleep which is not good for the developing brain. Children with Down syndrome have cognitive issues, which can worsen with untreated OSA. Adults with Down syndrome are more likely to have Alzheimer’s disease, a disorder in which there is gradual memory loss and ultimately death.

It is important to treat OSA and optimize brain function early in life to hopefully prevent or delay progression to developing Alzheimer’s disease when they become adults.

In addition, low oxygen level and the difficulty breathing seen in OSA strains the heart and can cause heart failure. Children with Down syndrome may have been born with heart defects and poor heart function, which can be worsened by OSA. For these reasons, it is important to diagnose and treat OSA as early as possible in children with Down syndrome.