Respiratory problems in people with Down syndrome

People with Down syndrome are prone to upper respiratory tract infections, due to multiple factors (eg small midface, reduced immunity). Respiratory infections and otitis media are very common in children with Down syndrome aged 1 to 5 years, and can recur and persist for many years, and impact on general health, hearing, learning and wellbeing.

For management advice, see Ear, nose and throat infections and Respiratory tract infections. For monitoring recommendations for hearing in children and adults with Down syndrome, see Hearing and vision problems.

Obstructive sleep apnoea (OSA) is extremely common and underdiagnosed in people of all ages with Down syndrome; prevalence is between 54 to 90%. As signs and symptoms do not correlate well with severity, all children and adults with Down syndrome should be screened for OSA. Common symptoms (eg snoring, daytime lethargy) may not be present. In people with Down syndrome, OSA may present with behavioural change (eg regression) and depression. Contributing factors include low muscle tone, obesity, adenotonsillar hypertrophy and anatomical abnormalities of the oropharynx and tongue.

Refer people with suspected OSA to a specialist (eg sleep physician, respiratory physician, paediatrician) for diagnosis and management; see also the Respiratory guidelines for advice on adults and children.