What the Latest Data Shows
-
A recent 2024 study on a group of infants/toddlers with Down Syndrome, found that over 90% of the group had Obstructive Sleep Apnoea (OSA) even in their first year of life. (PMC)
- In
preschool age (2-4 years), nearly all children with DS referred for sleep
studies had OSA; only about 5% did not have the condition. (Paediatrics)
- The severity
of OSA in these young children is also often high, with many showing
moderate to severe obstruction and, in some cases, accompanying nocturnal
hypoventilation or airway compromise. (Paediatrics)
Because Down Syndrome carries multiple anatomical and physiological
risk factors (for example, low muscle tone, narrow airway, large tongue,
enlarged tonsils/adenoids, etc.), infants and toddlers are especially vulnerable. (MDPI)
Subtle Signs of OSA in Infants
& Toddlers with Down Syndrome
Many classic symptoms (e.g. loud snoring) may or may not
be obvious; often the signs are subtle, especially in very young children.
Here are some signs to watch for:
Because many of these symptoms overlap with typical DS
issues (low tone, respiratory infections, feeding challenges, etc.), it's easy
to miss or under-estimate OSA. That’s why screening or formal evaluation is so
important.
What a Sleep Study
(Polysomnogram) Involves
If your paediatrician thinks there may be OSA (or as part
of routine monitoring for DS), they may recommend a sleep study.
Here's what
you can expect:
-
Overnight
testing: The child sleeps in a sleep lab (hospital or
clinic) overnight, though sometimes home sleep studies may be used
depending on availability and tolerability. (ndss.org)
- Sensors: The
child will wear sensors that monitor:
-
Brain
activity (EEG) to determine sleep stages
- Eye
movements
- Muscle
tone
- Breathing
patterns (airflow in nose/mouth, effort of chest and abdomen)
- Oxygen
saturation in the blood
Carbon
dioxide levels (in some studies, to detect hypoventilation) (Paediatrics)
- Heart
rate
Snoring
/ sound / position of body (Paediatrics)
What’s
measured / outcomes:
-
Apnoea-Hypopnea
Index (AHI): number of obstructive events per hour of sleep.
- Severity
(mild/moderate/severe) based on AHI, oxygen drops, CO₂ retention.
- Sleep
fragmentation: how often sleep is disrupted.
Duration
of low oxygen or elevated CO₂.
- Sometimes
positional effects: e.g. more obstruction when lying on back vs side. (Pediatrics)
After
the study: - Results are reviewed with you; may lead to
treatment options (surgery, CPAP, etc.). Also, follow-ups or repeated
studies may be needed, especially if treatment is done. (Paediatrics)
Questions to Ask Your
Paediatrician
To make sure you have a thorough conversation and don’t
miss anything, here are useful questions:
- When should we screen for OSA in my child with DS?
(E.g., “Do you recommend a sleep study by age 6 months? By 1 year? By 2
years?”)
- Do you
think my child is showing any of the subtle signs of OSA?
(Bring your observations: snoring, restless sleep, feeding problems,
behaviour.)
- If we
do a sleep study, is there a centre near us experienced with children with
DS?
- What
kind of sleep study would you recommend?
(Full in-lab PSG vs home monitoring vs shorter overnight studies.)
- What
are the risks if OSA is untreated in young children with DS?
(Includes effects on growth, heart, development, cognition, etc.)
- If OSA
is diagnosed, what treatment options might be considered?
(E.g., surgery (adenotonsillectomy), CPAP/BiPAP, positional therapy, etc.)
- How
will treatment success be evaluated? Do we repeat the sleep study?
- Are
there non-surgical options or conservative measures that might help?
(For example managing congestion, reflux, sleep positioning, weight if
relevant.)
- What
are potential side-effects or challenges of treatment (e.g. CPAP mask fit,
surgery risks)?
- Are
there developmental or behavioural supports to help if OSA is affecting
learning, attention, or speech?
Action Steps & Take-Home
Message
If your
child has Down syndrome, don’t wait for obvious snoring or breathing
pauses. Because the prevalence of OSA is very high even in infants and
toddlers, early screening is recommended. (PMC)
Keep
track of sleep behaviour and any of the subtle signs listed above; make
notes, even video/audio if feasible, to share with your doctor.
Advocate
for a sleep study if there are concerns, even if symptoms seem mild.
Early
diagnosis and treatment can improve quality of life: better sleep, better
heart health, better attention, enhanced growth and developmental
outcomes.
