Sleep-Disordered Breathing in Children with Down Syndrome in Saudi Arabia: Current Evidence and a Proposed Care Pathway

Background/Objectives: Children with Down syndrome are at increased risk of obstructive sleep apnea (OSA), which cannot be reliably excluded by symptoms or examination. Saudi evidence remains limited. This review synthesizes international and Saudi evidence and proposes a pediatric care pathway incorporating the transition to adult services. Methods: We conducted a structured narrative review of the English-language literature identified through PubMed/MEDLINE, selected journal websites, and reference lists. The review focused on publications from January 2018 to 17 September 2026, retaining relevant earlier studies. Evidence was synthesized qualitatively without a new meta-analysis or formal risk of bias assessment. Results: Published international estimates indicate that OSA affects approximately 50–79% of children with Down syndrome. American Academy of Pediatrics guidance recommends polysomnography (PSG) at ages 3–4 years regardless of symptoms, with earlier assessment when indicated. Nonrandomized infant intervention studies suggest potential benefits but do not establish an optimal universal screening schedule. Saudi evidence includes a small earlier PSG referral cohort and more recent caregiver surveys; no nationally representative PSG-confirmed prevalence study was identified. Arabic questionnaire validation in a mixed pediatric referral cohort does not establish Down syndrome-specific diagnostic accuracy. Published treatment evidence indicates that adenotonsillectomy often improves OSA, although residual disease commonly requires objective reassessment and individualized management. Conclusions: The evidence supports age-based PSG, earlier assessment when indicated, postoperative reassessment, and individualized multidisciplinary care. Building on this evidence, we propose a Saudi pathway linking referral tracking, family-centered positive airway pressure support, and coordinated transition. Regional networks and registry development remain unevaluated implementation proposals requiring stakeholder consultation, resource assessment, and pilot testing; they do not constitute an endorsed national guideline.