Children with Down Syndrome (DS) have many predisposing factors for the obstructive sleep apnea syndrome (OSAS), and removal of the tonsils and adenoids is the first-line treatment of airway obstruction and sleep apnea in children with DS. On the other hand, it is known that despite tonsillectomy and adenoidectomy, obstructive sleep apnea persists in 30-50% of children with DS. We investigate herein 4 patients who underwent tonsillectomy and adenoidectomy between January 2008 and December 2010. To evaluate the causes of OSAS in children with DS, we performed a comparative study of the degree of tonsillar hypertrophy, hypertrophy of adenoids, macroglossia, body weight, obesity, body mass index, oxygen saturation, apnea hypopnea index, period of operation, and the Mallampati test. Snoring and apnea improved in 2 cases (50%) after the operation, but OSAS remained in two cases (50%). Persistent sleep apnea in children with DS has multiple causes which include macroglossia, glossoptosis, enlarged lingual tonsils, hypopharyngeal collapse, and central sleep apnea. It is important to identify and characterize these potential causes.
