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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
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Positional obstructive sleep apnea in pediatric down syndrome: Prevalence and therapy implications

Debra M Don1, Beth Osterbauer2, Emily Gillett3

  • 1Children's Hospital Los Angeles, Division of Otolaryngology - Head and Neck Surgery, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA; Keck School of Medicine, University of Southern California, 1500 San Pablo St, Los Angeles, CA, 90033, USA.

International Journal of Pediatric Otorhinolaryngology
|April 3, 2026
PubMed

Insights

Children with Down syndrome (DS) have more severe obstructive sleep apnea (OSA) and may not benefit from positional therapy due to airway collapsibility. Individualized treatment is recommended for pediatric OSA in DS patients.

Area of Science:

  • Pediatric Sleep Medicine
  • Genetics and Rare Diseases
  • Respiratory Physiology

Background:

  • Children with Down syndrome (DS) possess unique anatomical features predisposing them to positional obstructive sleep apnea (POSA).
  • Investigating POSA prevalence and contributing factors in pediatric DS is crucial for understanding sleep-related breathing disorders.

Purpose of the Study:

  • To determine the prevalence of POSA in children with DS compared to a control group.
  • To identify predisposing factors for POSA in pediatric Down syndrome.

Main Methods:

  • Retrospective review of overnight polysomnograms for children with and without DS (November 2016 - December 2023).
  • POSA defined as an obstructive apnea-hypopnea index (OAHI) at least twice as high in supine vs. non-supine positions.
  • Collection and analysis of demographic and sleep data.

Main Results:

  • Children with DS exhibited more severe OSA across various sleep states and positions compared to controls.
  • While POSA prevalence was slightly higher in controls (48%) vs. DS (36%), DS children with POSA showed a more even distribution across all OSA severity categories.
  • Down syndrome was associated with decreased odds of having POSA (OR 0.45, p=0.042), despite more severe OSA overall.

Conclusions:

  • DS subjects present with more severe OSA and a tendency for significant apneic events regardless of body position or sleep stage.
  • Hypotonia and increased airway collapsibility are hypothesized as primary drivers of this OSA phenotype in DS.
  • Positional therapy requires individualized approaches for children with Down syndrome and OSA.
Abstract

Keywords:
ChildDown syndromeSleep apnea

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