Abstract
Children with Down syndrome have a very high risk for obstructive sleep apnea (OSA) attributable to multilevel obstruction. Adenotonsillectomy is only partially effective, and positive airway pressure use is met with noncompliance. Successful treatment of OSA in this population may lead to more meaningful improvements in quality of life and other outcomes than in children without Down syndrome. This chapter discusses the general approach to evaluating and managing upper airway obstruction in this high-risk population.