Obstructive sleep apnea syndrome in adults with down syndrome: Causes and consequences. Is it a chicken and egg question?

Individuals with Down syndrome present many clinical characteristics, such as metabolic, endocrine, anatomic and neurologic dysfunctions, that contribute to the physiopathology of obstructive sleep apnea syndrome (OSAS). As a result, sleep apnea prevalence is significantly greater in population with Down syndrome, and may have critical consequences on health and quality of life, such as cardiovascular risks and obesity. This paper compiles a list of specific risk factors of OSAS present in Down syndrome to explain the high prevalence of this sleep disorder. Endocrine, metabolic, and morphologic aspects are discussed, as well as cardiac, autonomic, genetic and lifestyle factors. Thus, the purpose of this review is to present risk factors, consequences and management of OSAS in the population with Down syndrome.