Obstructive sleep apnea syndrome secondary to pharyngolaryngomalacia in a neonate with Down syndrome

We described a case of obstructive sleep apnea secondary (OSAS) to pharyngomalacia and laryngomalacia in a neonate with Down syndrome. She presented with oxygen requirement and paradoxical breathing without stridor. Sleep polysomnography revealed obstructive apnea (obstructive apneic index of 14 h(-1)). Flexible bronchoscopy revealed collapsed velopharynx and omega-shaped larynx leading to the diagnosis of pharyngolaryngomalacia. She was treated with nasal prong continuous positive airway pressure. On this treatment, repeat polysomnography revealed abolition of obstructive apnea. Our case leads us to speculate that pharyngomalacia is an under-recognized condition in Down syndrome because this is expected to occur as part of generalized floppiness of airway of Down syndrome. In fact pharyngomalacia is a newly described clinical entity, which if unnoticed is associated with failure of supraglottoplasty in relieving symptoms of airway obstruction of laryngomalacia.