If a child is struggling to breathe, is floppy or will not wake, or their skin, lips or tongue look blue or grey: call 999 now. Colour changes are harder to see on brown and black skin, so check the palms, soles, lips and tongue. If you are worried but it is not an emergency, call NHS 111. In Northern Ireland use your GP out-of-hours service.

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Down's syndrome and sleep apnoea

Why it is more common, and the screening you may need to ask for.

The short version

  • Obstructive sleep apnoea is far more common with Down's syndrome. Signs: snoring, restless sleep, sleeping with the head tipped back, interrupted breathing, sweating, morning headache.
  • Expect professionals to take your concerns seriously. The signs you have noticed are not to be put down to your child having Down's syndrome.
  • The UK specialist group advises overnight pulse oximetry, once in infancy and then yearly until age five.
  • That is advice, not a guaranteed entitlement, so many families have to ask for it by name. A normal result does not rule apnoea out.
  • Because the airway can narrow in more than one place, surgery at a single site often does not fix everything.

The rest of this page explains where this comes from. You do not have to read it tonight.

About 2 minutes to read

Down's syndrome and sleep apnoea

Around half of children with Down's syndrome have sleep difficulties, and obstructive sleep apnoea is far more common than in other children. The Down's Syndrome Medical Interest Group (DSMIG, updated November 2024) gives 1 to 4% in typically developing children, "whilst in children with Down syndrome studies have shown an incidence between 30 and 77%"; the Down's Syndrome Association gives about 2% against "between 50 and 80 percent". A UK study of 188 children under 6 (Hill and colleagues, 2016) found moderate to severe apnoea in 14% and mild to moderate in 59%.

Why, in DSMIG's words: "midface hypoplasia and mandibular hypoplasia, relative enlargement of the tongue, obesity and hypotonia, predisposing to upper airway collapse at multiple levels". Both emphasised words matter: the tongue is large relative to the space available, and because the airway can narrow in more than one place, surgery at a single site often does not fix everything. DSMIG reports residual obstruction after tonsil and adenoid removal in up to 10 to 20% of children with Down syndrome. Signs to watch for include snoring, restless sleep, sleeping with the head tipped back, interrupted breathing, sweating, bedwetting, dry mouth, morning headache, and in younger children hyperactivity.

Screening: what to ask for, and why you may have to ask

DSMIG advises that all children with Down syndrome "should be offered screening with an overnight pulse oximetry, once in infancy and thereafter yearly till aged 5 years". That is what the UK specialist group advises, not a guaranteed NHS entitlement: sleep-disordered breathing is not on DSMIG's formal essential surveillance list, so many families have to ask for it by name. From the 2023 British Thoracic Society guideline: a normal oximetry result does not exclude sleep-disordered breathing, and questionnaires "should not be considered for diagnosing" it in children with other conditions.

The sentence to take to an appointment

From the Down's Syndrome Association: "You should expect professionals to take your concerns seriously; the signs that you have noticed should not just be put down to the fact that the person has Down's syndrome."

Where this comes from

Last checked 1 August 2026. This page is general information, not medical advice. If you are worried about your child, speak to your health visitor or GP.