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Endgames Picture Quiz

Sleep disordered breathing in a 4 year old child with Down’s syndrome

BMJ 2008; 337 doi: (Published 01 October 2008) Cite this as: BMJ 2008;337:a1229
  1. D S Urquhart, specialist registrar,
  2. L Perry, paediatric respiratory technician,
  3. A Gupta, specialist registrar,
  4. M Rosenthal, consultant
  1. 1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP
  1. Correspondence to: D S Urquhart donurquhart72{at}

    Case history

    A 4 year old boy with Down’s syndrome has a long history of sleep disturbance. He snores at night, his sleep is very restless, and he sleeps for long periods during the day while at nursery. He was admitted for an overnight sleep study, a six hour epoch of which is displayed below (fig 1). A treatment intervention improved sleep quality.

    Fig 1 Overnight sleep study showing transcutaneous carbon dioxide (CO2), oxygen saturation (SaO2), and heart recordings


    • 1. Describe the abnormalities shown.

    • 2. What is the probable explanation for these abnormalities?

    • 3. What is the intervention likely to be?


    Short answers

    • 1. The abnormalities are detailed in fig 2.

    Fig 2 Overnight sleep study showing abnormalities in transcutaneous carbon dioxide (CO2), oxygen saturation (SaO2), and heart recordings

    • 2. Sleep disordered breathing (obstructive sleep apnoea).

    • 3. The intervention, which improved sleep quality (fig 3), would have been adenotonsillectomy or institution of non-invasive ventilation. …

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