We describe the abnormal sleeping position as a unique presentation of obstructive sleep apnea in a boy with Down syndrome. Children with Down syndrome are at exceptionally high risk of developing obstructive sleep apnea. Unique sleeping positions, such as sitting and leaning forward, have been closely linked to sleep disordered breathing related symptoms in children with Down syndrome. Unusual sleeping positions in children with Down syndrome should prompt timely referral for sleep assessment to investigate for the presence of obstructive sleep apnea. All children with Down syndrome are recommended to have a baseline polysomnogram screening by age 4 years. Paediatric obstructive sleep apnea is an amenable condition that may lead to significant long-term consequences involving the neurobehavioural, cardiovascular, endocrine, and metabolic systems if left untreated. Adenotonsillectomy is the first-line surgical treatment for paediatric obstructive sleep apnea. Children with Down syndrome who experience residual obstructive sleep apnea symptoms after surgery should receive further nonsurgical interventions
