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Facial paralysis after a road traffic accident

Probably, this child's airways obstruction was not recognized sufficiently early to prevent complications; alternatively, it may not have been thought severe enough to cause that degree of pulmonary hypertension. Stebbens et al.1 described a cohort of 32 children with Down's syndrome of whom 31% showed evidence of sleeprelated airway obstruction. Southall et al.2 confirmed sleeprelated upper airway obstruction in 6 of the 12 children with Down's syndrome they studied. Rowland et al.3 and Loughlin et al.4 describe cases similar to ours. Early surgical treatment5'6 can prevent the development of life-threatening pulmonary and cardiac complications. We would advise that any child with Down's syndrome and pulmonary hypertension in the presence of a structurally normal heart should be assumed to have upper airways obstruction. Overnight saturation monitoring alone, without measurement of heart rate and air flow, is not sensitive enough to exclude obstructive sleep apnoea.