Obstructive Sleep Apnea in Children with Down Syndrome

  • Dennis RosenEmail author
Part of the Respiratory Medicine book series (RM)


Children with Down syndrome have certain characteristic physical features—including relative macroglossia, maxillary hypoplasia, and hypotonia—that put them at a much higher risk of obstructive sleep apnea (OSA) than the typical population. This chapter discusses the epidemiology, pathophysiology, and the consequences of Down syndrome that lead to OSA, as well as diagnosis and treatment for OSA in Down syndrome children.


Obstructive Sleep Apnea Continuous Positive Airway Pressure Down Syndrome Environmental Tobacco Smoke Exposure Typical Child 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Center for Disease Control. Improved national ­prevalence estimates for 18 selected major birth defects, United States, 1999–2001. MMWR. 2006;54 (51 & 52):1301–5.­preview/mmwrhtml/mm5451a2.htm. Accessed 6 Jan 2010.
  2. 2.
    Lumeng JC, Chervin RD. Epidemiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:242–52.PubMedGoogle Scholar
  3. 3.
    Fitzgerald DA, Paul A, Richmond C. Severity of obstructive apnoea in children with Down syndrome who snore. Arch Dis Child. 2007;92:423–5.PubMedGoogle Scholar
  4. 4.
    Shott SR, Amin R, Chini B, Heubi C, Hotze S, Akers R. Obstructive sleep apnea: should all children with Down syndrome be tested? Arch Otolaryngol Head Neck Surg. 2006;132:432–6.PubMedGoogle Scholar
  5. 5.
    Dahlqvist A, Rask E, Rosenqvist CJ, Sahlin C, Franklin KA. Sleep apnea and Down’s syndrome. Acta Otolaryngol. 2003;123:1094–7.PubMedGoogle Scholar
  6. 6.
    Resta O, Barbaro MP, Giliberti T, et al. Sleep related breathing disorders in adults with Down syndrome. Downs Syndr Res Pract. 2003;8:115–9.PubMedGoogle Scholar
  7. 7.
    Marcus CL, Keens TG, Bautista DB, von Pechmann WS, Ward SL. Obstructive sleep apnea in children with Down syndrome. Pediatrics. 1991;88:132–9.PubMedGoogle Scholar
  8. 8.
    Southall DP, Stebbens VA, Mirza R, Lang MH, Croft CB, Shinebourne EA. Upper airway obstruction with hypoxaemia and sleep disruption in Down syndrome. Dev Med Child Neurol. 1987;29:734–42.PubMedGoogle Scholar
  9. 9.
    Ng DK, Hui HN, Chan CH, et al. Obstructive sleep apnoea in children with Down syndrome. Singapore Med J. 2006;47:774–9.PubMedGoogle Scholar
  10. 10.
    Stebbens VA, Dennis J, Samuels MP, Croft CB, Southall DP. Sleep related upper airway obstruction in a cohort with Down’s syndrome. Arch Dis Child. 1991;66:1333–8.PubMedGoogle Scholar
  11. 11.
    de Miguel-Díez J, Villa-Asensi JR, Alvarez-Sala JL. Prevalence of sleep-disordered breathing in children with Down syndrome: polygraphic findings in 108 children. Sleep. 2003;26:1006–9.PubMedGoogle Scholar
  12. 12.
    Dyken ME, Lin-Dyken DC, Poulton S, Zimmerman MB, Sedars E. Prospective polysomnographic analysis of obstructive sleep apnea in Down syndrome. Arch Pediatr Adolesc Med. 2003;157:655–60.PubMedGoogle Scholar
  13. 13.
    Trois MS, Capone GT, Lutz JA, et al. Obstructive sleep apnea in adults with Down syndrome. J Clin Sleep Med. 2009;5:317–23.PubMedGoogle Scholar
  14. 14.
    Fink GB, Madaus WK, Walker GF. A quantitative study of the face in Down’s syndrome. Am J Orthod. 1975;67:540–53.PubMedGoogle Scholar
  15. 15.
    Uong EC, McDonough JM, Tayag-Kier CE, et al. Magnetic resonance imaging of the upper airway in children with Down syndrome. Am J Respir Crit Care Med. 2001;163:731–6.PubMedGoogle Scholar
  16. 16.
    Guimaraes CV, Donnelly LF, Shott SR, Amin RS, Kalra M. Relative rather than absolute macroglossia in patients with Down syndrome: implications for treatment of obstructive sleep apnea. Pediatr Radiol. 2008;38:1062–7.PubMedGoogle Scholar
  17. 17.
    Shott SR, Donnelly LF. Cine magnetic resonance imaging: evaluation of persistent airway obstruction after tonsil and adenoidectomy in children with Down syndrome. Laryngoscope. 2004;114:1724–9.PubMedGoogle Scholar
  18. 18.
    Donnelly LF, Shott SR, LaRose CR, Chini BA, Amin RS. Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with Down syndrome as depicted on static and dynamic cine MRI. AJR Am J Roentgenol. 2004;183:175–81.PubMedGoogle Scholar
  19. 19.
    Donnelly LF, Strife JL, Myer 3rd CM. Glossoptosis (posterior displacement of the tongue) during sleep: a frequent cause of sleep apnea in pediatric patients referred for dynamic sleep fluoroscopy. AJR Am J Roentgenol. 2000;175:1557–60.PubMedGoogle Scholar
  20. 20.
    Mitchell RB, Call E, Kelly J. Diagnosis and therapy for airway obstruction in children with Down syndrome. Arch Otolaryngol Head Neck Surg. 2003;129:642–5.PubMedGoogle Scholar
  21. 21.
    Sivan Y, Ward SD, Deakers T, Keens TG, Newth CJ. Rib cage to abdominal asynchrony in children undergoing polygraphic sleep studies. Pediatr Pulmonol. 1991;11:141–6.PubMedGoogle Scholar
  22. 22.
    Shing Yan Robert L, Daniel Kwok-Keung N, Pok Yu C, Ka Li K. Obstructive sleep apnea syndrome secondary to pharyngolaryngomalacia in a neonate with Down syndrome. Int J Pediatr Otorhinolaryngol. 2005;69:919–21.PubMedGoogle Scholar
  23. 23.
    Rubin SS, Rimmer JH, Chicoine B, Braddock D, McGuire DE. Overweight prevalence in persons with Down syndrome. Ment Retard. 1998;36:175–81.PubMedGoogle Scholar
  24. 24.
    Redline S, Tishler PV, Schluchter M, Aylor J, Clark K, Graham G. Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med. 1999;159:1527–32.PubMedGoogle Scholar
  25. 25.
    Shires CB, Anold SL, Schoumacher RA, Dehoff GW, Donepudi SK, Stocks RM. Body mass index as an indicator of obstructive sleep apnea in pediatric Down syndrome. Int J Pediatr Otorhinolaryngol. 2010;74(7): 768–72.PubMedGoogle Scholar
  26. 26.
    Fricke BL, Donnelly LF, Shott SR, et al. Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls. Pediatr Radiol. 2006;36:518–23.PubMedGoogle Scholar
  27. 27.
    Rosen D. Severe hypothyroidism presenting as obstructive sleep apnea. Clin Pediatr (Phila). 2010; 49(4):381–3.Google Scholar
  28. 28.
    Gibson PA, Newton RW, Selby K, Price DA, Leyland K, Addison GM. Longitudinal study of thyroid function in Down’s syndrome in the first two decades. Arch Dis Child. 2005;90:574–8.PubMedGoogle Scholar
  29. 29.
    Skjodt NM, Atkar R, Easton PA. Screening for hypothyroidism in sleep apnea. Am J Respir Crit Care Med. 1999;160:732–5.PubMedGoogle Scholar
  30. 30.
    Kapur VK, Koepsell TD, deMaine J, Hert R, Sandblom RE, Psaty BM. Association of hypothyroidism and obstructive sleep apnea. Am J Respir Crit Care Med. 1998;158(5 Pt 1):1379–83.PubMedGoogle Scholar
  31. 31.
    Winkelman JW, Goldman H, Piscatelli N, Lukas SE, Dorsey CM, Cunningham S. Are thyroid function tests necessary in patients with suspected sleep apnea? Sleep. 1996;19:790–3.PubMedGoogle Scholar
  32. 32.
    American Academy of Pediatrics, Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics. 2001;107:442–9.Google Scholar
  33. 33.
    Ferri R, Curzi-Dascalova L, Del Gracco S, Elia M, Musumeci SA, Pettinato S. Heart rate variability and apnea during sleep in Down’s syndrome. J Sleep Res. 1998;7:282–7.PubMedGoogle Scholar
  34. 34.
    Ferri R, Curzi-Dascalova L, Del Gracco S, Elia M, Musumeci SA, Stefanini MC. Respiratory patterns during sleep in Down’s syndrome: importance of central apnoeas. J Sleep Res. 1997;6:134–41.PubMedGoogle Scholar
  35. 35.
    Telakivi T, Partinen M, Salmi T, Leinonen L, Härkönen T. Nocturnal periodic breathing in adults with Down’s syndrome. J Ment Defic Res. 1987;31(Pt 1):31–9.PubMedGoogle Scholar
  36. 36.
    Clark RW, Schmidt HS, Schuller DE. Sleep-induced ventilatory dysfunction in Down’s syndrome. Arch Intern Med. 1980;140:45–50.PubMedGoogle Scholar
  37. 37.
    Halbower AC, Degaonkar M, Barker PB, et al. Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Med. 2006;3:e301.PubMedGoogle Scholar
  38. 38.
    Mitchell RB, Kelly J. Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy. Laryngoscope. 2007;117:1685–8.PubMedGoogle Scholar
  39. 39.
    Huan YS, Guilleminault C, Li HY, Yang CM, Wu YY, Chen NH. Attention-deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med. 2007;8:18–30.Google Scholar
  40. 40.
    Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. 2006;117:e769–78.PubMedGoogle Scholar
  41. 41.
    Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics. 1998;102:616–20.PubMedGoogle Scholar
  42. 42.
    Andreou G, Galanopoulou C, Gourgoulianis K, Karapetsas A, Molyvdas P. Cognitive status in Down syndrome individuals with sleep disordered breathing deficits (SDB). Brain Cogn. 2002;50:145–9.PubMedGoogle Scholar
  43. 43.
    Carskadon MA, Pueschel SM, Millman RP. Sleep-disordered breathing and behavior in three risk groups: preliminary findings from parental reports. Childs Nerv Syst. 1993;9:452–7.PubMedGoogle Scholar
  44. 44.
    Rihtman T, Tekuzener E, Parush S, Tenenbaum A, Bachrach SJ, Ornoy A. Are the cognitive functions of children with Down syndrome related to their participation? Dev Med Child Neurol. 2010;52: 72–8.PubMedGoogle Scholar
  45. 45.
    Freezer NJ, Bucens IK, Robertson CF. Obstructive sleep apnoea presenting as failure to thrive in infancy. J Paediatr Child Health. 1995;31:172–5.PubMedGoogle Scholar
  46. 46.
    Brouillette RT, Fernacbh SK, Hunt CE. Obstructive sleep apnea in infants and children. J Pediatr. 1982;100:31–40.PubMedGoogle Scholar
  47. 47.
    Li AM, Au CT, Sung RYT, et al. Ambulatory blood pressure in children with obstructive sleep apnoea—a community based study. Thorax. 2008;63:803–9.PubMedGoogle Scholar
  48. 48.
    Tamura A, Kawano Y, Watanabe T, Kadota J. Relationship between the severity of obstructive sleep apnea and impaired glucose metabolism in patients with obstructive sleep apnea. Respir Med. 2008;102: 1412–6.PubMedGoogle Scholar
  49. 49.
    Lam JC, Ip MS. Obstructive sleep apnea and the metabolic syndrome. Expert Rev Respir Med. 2009;3: 177–86.PubMedGoogle Scholar
  50. 50.
    Parish J, Somers V. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc. 2004;79: 1036–46.PubMedGoogle Scholar
  51. 51.
    Nishibayashi M, Miyamoto M, Miyamoto T, Suzuki K, Hirata K. Correlation between severity of obstructive sleep apnea and prevalence of silent cerebrovascular lesions. J Clin Sleep Med. 2008;4:242–7.PubMedGoogle Scholar
  52. 52.
    Eipe N, Lai L, Doherty DR. Severe pulmonary hypertension and adenotonsillectomy in a child with Trisomy-21 and obstructive sleep apnea. Paediatr Anaesth. 2009;19:548–9.PubMedGoogle Scholar
  53. 53.
    Loughlin GM, Wynne JW, Victorica BE. Sleep apnea as a possible cause of pulmonary hypertension in Down syndrome. J Pediatr. 1981;98:435–7.PubMedGoogle Scholar
  54. 54.
    Jacobs IN, Teague WG, Bland Jr JW. Pulmonary vascular complications of chronic airway obstruction in children. Arch Otolaryngol Head Neck Surg. 1997;123:700–4.PubMedGoogle Scholar
  55. 55.
    Levine OR, Simpser M. Alveolar hypoventilation and cor pulmonale associated with chronic airway obstruction in infants with Down syndrome. Clin Pediatr (Phila). 1982;21:25–9.Google Scholar
  56. 56.
    Ayeni TI, Roper HP. Pulmonary hypertension resulting from upper airways obstruction in Down’s syndrome. J R Soc Med. 1998;91:321–2.PubMedGoogle Scholar
  57. 57.
    Cua CL, Blankenship A, North AL, Hayes J, Nelin LD. Increased incidence of idiopathic persistent pulmonary hypertension in Down syndrome neonates. Pediatr Cardiol. 2007;28:250–4.PubMedGoogle Scholar
  58. 58.
    Shah PS, Hellmann J, Adatia I. Clinical characteristics and follow up of Down syndrome infants without congenital heart disease who presented with persistent pulmonary hypertension of newborn. J Perinat Med. 2004;32:168–70.PubMedGoogle Scholar
  59. 59.
    Weijerman ME, van Furth AM, van der Mooren MD, et al. Prevalence of congenital heart defects and persistent pulmonary hypertension of the neonate with Down syndrome. Eur J Pediatr. 2010;169(10): 1195–9.PubMedGoogle Scholar
  60. 60.
    Richalet JP, Chenivesse C, Larmignat P, Meille L. High altitude pulmonary edema, down syndrome, and obstructive sleep apneas. High Alt Med Biol. 2008;9:179–81.PubMedGoogle Scholar
  61. 61.
    Levanon A, Tarasiuk A, Tal A. Sleep characteristics in children with Down syndrome. J Pediatr. 1999;134: 755–60.PubMedGoogle Scholar
  62. 62.
    McKay SM, Angulo-Barroso RM. Longitudinal assessment of leg motor activity and sleep patterns in infants with and without Down syndrome. Infant Behav Dev. 2006;29:153–68.PubMedGoogle Scholar
  63. 63.
    Dominguez-Ortega L, Salin-Pascual RJ, Díaz-Gállego E. Narcolepsy-like symptoms in a patient with Down syndrome and without obstructive sleep apnea. Sleep. 2003;26:285–6.PubMedGoogle Scholar
  64. 64.
    Ng DK, Chan CH, Cheung JM. Children with Down syndrome and OSA do not necessarily snore. Arch Dis Child. 2007;92:1047–8.PubMedGoogle Scholar
  65. 65.
    Rosen D. Many parents report their child’s breathing and sleep patterns during overnight sleep study as atypical. Clin Pediatr (Phila). 2010;49(8):764–7.Google Scholar
  66. 66.
    Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2002;109:704–12.Google Scholar
  67. 67.
    Kuehni CE, Strippoli MP, Chauliac ES, Silverman M. Snoring in preschool children: prevalence, severity and risk factors. Eur Respir J. 2008;31:326–33.PubMedGoogle Scholar
  68. 68.
    Kheirandish-Gozal L, Gozal D. Intranasal budesonide treatment for children with mild obstructive sleep apnea syndrome. Pediatrics. 2008;122:e149–55.PubMedGoogle Scholar
  69. 69.
    Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children. Am J Respir Crit Care Med. 2005;172:364–70.PubMedGoogle Scholar
  70. 70.
    Sato K, Shirakawa T, Niikuni N, Sakata H, Asanuma S. Effects of oral care in Down syndrome children with obstructive sleep apnea. J Oral Sci. 2010;52:145–7.PubMedGoogle Scholar
  71. 71.
    Hawn J, Rice C, Nichols H, McDermott S. Overweight and obesity among children with Down syndrome: a descriptive study of children attending a Down syndrome clinic in South Carolina. J S C Med Assoc. 2009;105:64–8.PubMedGoogle Scholar
  72. 72.
    Wijga AH, Scholtens S, Wieringa MH, et al. Adenotonsillectomy and the development of overweight. Pediatrics. 2009;123:1095–101.PubMedGoogle Scholar
  73. 73.
    Mitchell RB. Adenotonsillectomy for obstructive sleep apnea in children: outcome evaluated by pre- and postoperative polysomnography. Laryngoscope. 2007;117:1844–54.PubMedGoogle Scholar
  74. 74.
    Goldstein NA, Armfield DR, Kingsley LA, Borland LM, Allen GC, Post JC. Postoperative complications after tonsillectomy and adenoidectomy in children with Down syndrome. Arch Otolaryngol Head Neck Surg. 1998;124:171–6.PubMedGoogle Scholar
  75. 75.
    Bower CM, Richmond D. Tonsillectomy and adenoidectomy in patients with Down syndrome. Int J Pediatr Otorhinolaryngol. 1995;33:141–8.PubMedGoogle Scholar
  76. 76.
    Roodman S, Bothwell M, Tobias JD. Bradycardia with sevoflurane induction in patients with trisomy 21. Paediatr Anaesth. 2003;13:538–40.PubMedGoogle Scholar
  77. 77.
    Luscri N, Tobias JD. Monitored anesthesia care with a combination of ketamine and dexmedetomidine ­during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea. Paediatr Anaesth. 2006;16:782–6.PubMedGoogle Scholar
  78. 78.
    Uno K, Kataoka O, Shiba R. Occipitoatlantal and occipitoaxial hypermobility in Down syndrome. Spine (Phila Pa 1976). 1996;21:1430–4.Google Scholar
  79. 79.
    Don DM, Geller KA, Koempel JA, Ward SD. Age specific differences in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2009;73: 1025–8.PubMedGoogle Scholar
  80. 80.
    Statham MM, Elluru RG, Buncher R, Kalra M. Adenotonsillectomy for obstructive sleep apnea syndrome in young children: prevalence of pulmonary complications. Arch Otolaryngol Head Neck Surg. 2006;132:476–80.PubMedGoogle Scholar
  81. 81.
    Mitchell RB, Kelly J. Outcome of adenotonsillectomy for obstructive sleep apnea in children under 3 years. Otolaryngol Head Neck Surg. 2005;132:681–4.PubMedGoogle Scholar
  82. 82.
    Slovik Y, Tal A, Shapira Y, Tarasiuk A, Leiberman A. Complications of adenotonsillectomy in children with OSAS younger than 2 years of age. Int J Pediatr Otorhinolaryngol. 2003;67:847–51.PubMedGoogle Scholar
  83. 83.
    Brigance JS, Miyamoto RC, Schilt P. Surgical management of obstructive sleep apnea in infants and young toddlers. Otolaryngol Head Neck Surg. 2009;140:912–6.PubMedGoogle Scholar
  84. 84.
    Marcus CL, Ward SL, Mallory GB, et al. Use of nasal continuous positive airway pressure as treatment of childhood obstructive sleep apnea. J Pediatr. 1995;127:88–94.PubMedGoogle Scholar
  85. 85.
    Marcus CL, Rosen G, Ward SL, et al. Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea. Pediatrics. 2006;117:e442–51.PubMedGoogle Scholar
  86. 86.
    Li KK, Riley RW, Guilleminault C. An unreported risk in the use of home nasal continuous positive airway pressure and home nasal ventilation in children. Chest. 2000;117:916–8.PubMedGoogle Scholar
  87. 87.
    Villa MP, Pagani J, Ambrosio R, et al. Mid-face hypoplasia after long-term nasal ventilation. Am J Respir Crit Care Med. 2002;166:1142–3.PubMedGoogle Scholar
  88. 88.
    Rosen D. Some infants with Down syndrome spontaneously outgrow their obstructive sleep apnea. Clin Pediatr (Phila). 2010;49(11):1068–71.Google Scholar
  89. 89.
    Yan Robert L, Daniel Kwok-Keung N, Pok Yu C, Ka Li K. Obstructive sleep apnea syndrome secondary to pharyngolaryngomalacia in a neonate with Down syndrome. Int J Pediatr Otorhinolaryngol. 2005;69: 919–21.Google Scholar
  90. 90.
    Al-Samri M, Mitchell I, Drummond DS, Bjornson C. Tracheostomy in children: a population-based experience over 17 years. Pediatr Pulmonol. 2010;45: 487–93.PubMedGoogle Scholar
  91. 91.
    O’Donnell AR, Bjornson CL, Bohn SG, Kirk VG. Compliance rates in children using noninvasive continuous positive airway pressure. Sleep. 2006;29: 651–8.PubMedGoogle Scholar
  92. 92.
    Kirk VG, O’Donnell AR. Continuous positive airway pressure for children: a discussion on how to maximize compliance. Sleep Med Rev. 2006;10:119–27.PubMedGoogle Scholar
  93. 93.
    Miloro M. Mandibular distraction osteogenesis for pediatric airway management. J Oral Maxillofac Surg. 2010;68:1512–23.PubMedGoogle Scholar
  94. 94.
    de Moura CP, Andrade D, Cunha LM, et al. Down syndrome: otolaryngological effects of rapid maxillary expansion. J Laryngol Otol. 2008;122:1318–24.PubMedGoogle Scholar
  95. 95.
    Burstein FD, Cohen SR, Scott PH, Teague GR, Montgomery GL, Kattos AV. Surgical therapy for severe refractory sleep apnea in infants and children: application of the airway zone concept. Plast Reconstr Surg. 1995;96:34–41.PubMedGoogle Scholar
  96. 96.
    Lefaivre JF, Cohen SR, Burstein FD, et al. Down syndrome: identification and surgical management of obstructive sleep apnea. Plast Reconstr Surg. 1997;99:629–37.PubMedGoogle Scholar
  97. 97.
    Jacobs IN, Gray RF, Todd NW. Upper airway obstruction in children with Down syndrome. Arch Otolaryngol Head Neck Surg. 1996;122:945–50.PubMedGoogle Scholar
  98. 98.
    Donaldson JD, Redmond WM. Surgical management of obstructive sleep apnea in children with Down syndrome. J Otolaryngol. 1988;17: 398–403.PubMedGoogle Scholar
  99. 99.
    Phillips DE, Rogers JH. Down’s syndrome with lingual tonsil hypertrophy producing sleep apnoea. J Laryngol Otol. 1988;102:1054–5.PubMedGoogle Scholar
  100. 100.
    Merrell JA, Shott SR. OSAS in Down syndrome: T&A versus T&A plus lateral pharyngoplasty. Int J Pediatr Otorhinolaryngol. 2007;71:1197–203.PubMedGoogle Scholar
  101. 101.
    Shete MM, Stocks RM, Sebelik ME, Schoumacher RA. Effects of adeno-tonsillectomy on polysomnography patterns in Down syndrome children with obstructive sleep apnea: a comparative study with children without Down syndrome. Int J Pediatr Otorhinolaryngol. 2010;74:241–4.PubMedGoogle Scholar
  102. 102.
    Rosen D, Lombardo A, Skotko B, Davidson EJ. Parental perceptions of sleep disturbances and sleep disordered breathing in children with Down syndrome. Clin Pediatr. 2011;50:121–5.PubMedGoogle Scholar
  103. 103.
    Tauman R, Gulliver TE, Krishna J, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr. 2006;149:803–8.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Division of Respiratory DiseasesChildren’s Hospital Boston, Harvard Medical SchoolBostonUSA

Personalised recommendations