Skip to content
How It Works
Explore
Ask a Question Resources Pricing
Who It's For
Patients
Decode results, prep for appointments, weigh options.
Caregivers & advocates
Carry the research load for someone you love.
Providers & clinicians
Resources for patients in your practice.
Log In Sign Up
PubMed This is a summary of 35 peer-reviewed journal articles Updated
Pediatric pulmonology · Trisomy 18

What Treatments Are Available for Sleep Apnea in Trisomy 18?

At a Glance

Treatment for sleep apnea and airway problems in trisomy 18 depends on whether the cause is blockage, shallow breathing, or a central breathing pause. Care may include CPAP or BiPAP, oxygen, surgery, or tracheostomy, with specialist monitoring and family-centered planning.

In this answer

5 sections

01

Getting the Right Evaluation

02

Non-Surgical Treatments and Daily Care

03

Surgical and Airway Procedures

04

Home Equipment, Emergencies, and Caregiver Training

05

Aligning Treatment with Your Family’s Goals

For a child with trisomy 18, treatments for sleep apnea and airway problems range from noninvasive breathing support (like positive airway pressure) to airway surgeries. Because children with trisomy 18 often have unique facial structures, low muscle tone (hypotonia), and neurological differences, airway blockages can happen at multiple points in the nose, throat, or windpipe (multilevel obstruction) [1]. Treatment is highly individualized; the right approach depends on the specific cause of the apnea, the child’s overall safety, and what best supports the family’s goals for their child’s quality of life [2][3].

Getting the Right Evaluation

Before starting treatment, it is essential to understand exactly why your child is having breathing problems. Not all apnea in trisomy 18 is caused by a physical blockage (obstructive sleep apnea). Some infants have central sleep apnea, where the brain pauses its signal to breathe, or apnea caused by underlying seizures [4][5].

To pinpoint the cause, your care team may recommend:

  • A Sleep Study (Polysomnography): This overnight test is the gold standard for diagnosing sleep apnea. For children with trisomy 18, the study should include carbon dioxide (CO2) monitoring to check if the child is hypoventilating (breathing too shallowly, causing CO2 to build up) [6][7].
  • Neurology Review: If an infant experiences apnea accompanied by stiffening, unusual movements, or prolonged color changes, a neurologist may perform an EEG to check for seizures, which require anti-seizure medication rather than just airway treatments [5].
  • Specialist Airway Evaluations: An evaluation by a pediatric pulmonologist (lung specialist) and an otolaryngologist (ENT doctor) is often necessary. They may use a flexible camera (endoscopy) to look inside your child’s airway to find structural issues [8][9].
  • Feeding and Swallowing Assessment: Coughing or choking with feeds, wet breathing, or recurrent chest infections can indicate aspiration (food or liquid entering the lungs) [9][10]. A swallow study can help ensure feeding safety, which is a critical part of overall airway health.

Non-Surgical Treatments and Daily Care

For many families, non-surgical approaches are the primary way to manage airway problems.

  • Safe Sleep and Positioning: For infants, the safest sleep position is on their back on a firm, flat surface without loose items. While certain positions (like side-sleeping or wedges) might seem to help breathing, they can increase the risk of suffocation and should never be used unless specifically prescribed and closely supervised by your child’s airway team [1].
  • Secretion Management: Suctioning can help clear pooling saliva, but unsupervised, deep, or repeated suctioning can injure the airway lining or slow the heart rate [9]. Medications to dry secretions can sometimes make mucus dangerously thick. Always follow your medical team’s specific training for suctioning.
  • Oxygen Therapy: Supplemental home oxygen can help maintain safe oxygen levels [11]. However, oxygen does not fix physical blockages and can mask shallow breathing and dangerous CO2 buildup (since standard home pulse oximeters only measure oxygen, not CO2) [12]. It must be strictly monitored by a doctor.
  • Continuous Positive Airway Pressure (CPAP) and Bilevel Positive Airway Pressure (BiPAP): These machines blow pressurized air through a mask. CPAP provides steady pressure to splint an obstructed upper airway open [13]. BiPAP provides two different pressures and is often used when a child has hypoventilation or central sleep apnea [14]. The exact device and pressure settings must be prescribed by a specialist [15].
  • High-Flow Nasal Cannula (HFNC) & Nasopharyngeal Airway (NPA): HFNC delivers heated, pressurized air through nasal prongs, and an NPA is a specialized tube placed through the nose into the throat [16][17]. While sometimes used for trisomy 18 based on small case studies, these are invasive options that do not replace CPAP/BiPAP. An NPA requires specialist sizing, securing, and a strict plan for bleeding, blockage, or vomiting [17][18].

Surgical and Airway Procedures

When structural issues are identified, ENT specialists might recommend surgery. However, because children with trisomy 18 often have multilevel obstructions, low muscle tone, and heart defects, surgery requires careful multidisciplinary planning and postoperative intensive care [19][20]. Surgery often does not completely cure apnea, and a repeat sleep study is usually needed to check for residual disease [6][21].

  • Tonsillectomy and Adenoidectomy: Removing enlarged tonsils and adenoids can help, but it may not fully resolve apnea if the child also has a floppy airway or low muscle tone [9][20].
  • Supraglottoplasty: If a child has severe laryngomalacia (a floppy voice box that collapses inward), a surgeon can trim the excess tissue. This requires close monitoring for postoperative swelling, bleeding, or aspiration [22][23].
  • Tracheostomy: For severe blockages or when a child needs long-term ventilation, a tracheostomy (a surgical opening in the neck into the windpipe) bypasses much of the upper airway [24][25]. However, a “trach” does not fix central apnea, lower-airway disease, or prevent aspiration. The tube can become blocked with mucus or accidentally pulled out (decannulated), representing a major life transition that requires extensive, round-the-clock specialized home nursing [26].

Home Equipment, Emergencies, and Caregiver Training

Bringing home respiratory equipment changes daily family life. Before leaving the hospital, caregivers must receive hands-on, competency-based training [27][28].

Your written discharge plan must include:

  • A response plan for all equipment alarms (never silence or change alarm settings without medical direction to avoid “alarm fatigue”) [29].
  • Training on mask fitting and preventing skin breakdown [30].
  • Backup plans for power outages, equipment failure, and backup oxygen [28].
  • For tracheostomies: Emergency steps for accidental decannulation or blockage, manual ventilation training, and keeping spare trach tubes on hand [26].

Seek Urgent Medical Help If:
Your child develops a blue or gray color, severe work of breathing (tugging at the chest or neck), unusually prolonged pauses in breathing, an inability to awaken, repeated equipment alarms that cannot be resolved, or if a tracheostomy tube appears blocked or displaced. Call emergency services immediately.

Aligning Treatment with Your Family’s Goals

Decisions about airway management are deeply personal. Families must weigh the benefits of interventions (like improved sleep or prolonged life) against the potential burdens (like repeated hospitalizations, intensive home nursing, or discomfort) [31][32].

Your medical team should use shared decision-making, offering treatments based on your child’s unique symptoms and your family’s definition of quality of life—not solely based on the genetic diagnosis [2][33]. Early involvement of palliative care provides an extra layer of support. Palliative care is not just for the end of life; it helps you navigate complex choices alongside active treatments, ensuring your child’s care plan remains flexible as their needs change [34][35].

Common questions in this guide

What treatments can help a child with trisomy 18 who has sleep apnea?
Treatment depends on whether the breathing problem comes from an airway blockage, shallow breathing, a central pause in breathing, or seizures. Options may include CPAP or BiPAP, carefully monitored oxygen, airway devices, surgery, or a tracheostomy for severe obstruction. A pediatric airway team should match treatment to the child's sleep study, airway findings, safety needs, and family goals.
Is CPAP or BiPAP used for sleep apnea in trisomy 18?
CPAP uses one steady air pressure to help hold an obstructed upper airway open. BiPAP uses two pressure levels and may be considered when a child has shallow breathing, carbon dioxide buildup, or central sleep apnea. A specialist must prescribe the device and pressure settings.
What testing is needed before choosing an airway treatment?
An overnight sleep study can identify obstructive apnea, central apnea, and shallow breathing, and carbon dioxide monitoring is important when hypoventilation is possible. Airway specialists may use a small flexible camera to look for structural blockage, while a swallow study can assess choking or aspiration. Neurology evaluation may be needed when pauses occur with unusual movements or other possible seizure signs.
Can airway surgery cure sleep apnea in a child with trisomy 18?
Removing enlarged tonsils and adenoids or treating severe laryngomalacia may improve a structural blockage. Because children with trisomy 18 can have blockage at several airway levels and low muscle tone, apnea may continue after surgery. A repeat sleep study is usually needed to check whether treatment worked fully.
Does a tracheostomy treat every type of apnea?
A tracheostomy can bypass much of the upper airway when blockage is severe or long-term ventilation is needed. It does not correct central apnea, lower-airway disease, or aspiration, and it requires extensive caregiver training, emergency planning, and often round-the-clock home nursing.
What should caregivers learn before taking respiratory equipment home?
Caregivers should receive hands-on training for the equipment, mask fit, skin protection, alarms, suctioning, and emergency responses. The written plan should address power outages, equipment failure, backup oxygen, and what to do if a tracheostomy tube becomes blocked or displaced. Blue or gray color, severe work of breathing, prolonged breathing pauses, inability to wake the child, or unresolved equipment alarms require urgent emergency help.

Related questions

How Accurate Is a Positive NIPT for Trisomy 18? Next Steps What Is the Trisomy 18 Recurrence Risk in Pregnancy? What Is the Life Expectancy and Survival Rate for Trisomy 18? Prenatal Trisomy 18 Positive: Why Is Newborn Blood Negative? How Does CVS Compare With Amniocentesis for Trisomy 18?
Show more
How Are Weight Gain and Nutrition Managed in Trisomy 18? What Does Mosaic Trisomy 18 on CVS With Normal Amnio Mean? Why Do Parents Need Karyotype Testing After Trisomy 18? Can Prenatal Ultrasound Predict Trisomy 18 Outcomes? How Common Is Trisomy 18? Pregnancy and Birth Rates How Do I Understand My Baby's Trisomy 18 Genetic Report? What Does Comfort Care Include for Newborns With Trisomy 18? What Happens After a Trisomy 18 Diagnosis at Birth? How Are Breathing Problems Evaluated in Trisomy 18? Can Blood Testing Miss Mosaic Trisomy 18? Other Tissue Tests Trisomy 18: How Are Swallowing and Aspiration Evaluated? What congenital heart defects occur in trisomy 18? Which Newborn Tests Help With Trisomy 18 Comfort Care? Where Is the Best Place to Deliver a Baby With Trisomy 18?

Get notified when new evidence is published on Trisomy 18 syndrome.

We monitor PubMed for new peer-reviewed studies on this topic and email a short summary when something meaningful changes.

References

References (35)
  1. 1

    Sleep disordered breathing in children with trisomy 13 and trisomy 18.

    Kettler EB, Bhattacharjee R, Lesser D, Nation J

    American journal of otolaryngology 2020; (41(6)):102555 doi:10.1016/j.amjoto.2020.102555.

    PMID: 32522368
  2. 2

    Guidance for Caring for Infants and Children With Trisomy 13 and Trisomy 18: Clinical Report.

    Pyle AK, George TN, Cummings JJ, et al.

    Pediatrics 2025; (156(2)) doi:10.1542/peds.2025-072719.

    PMID: 40685149
  3. 3

    Shared decision making and the pathways approach in the prenatal and postnatal management of the trisomy 13 and trisomy 18 syndromes.

    Andrews SE, Downey AG, Showalter DS, et al.

    American journal of medical genetics. Part C, Seminars in medical genetics 2016; (172(3)):257-63 doi:10.1002/ajmg.c.31524.

    PMID: 27557275
  4. 4

    Management of apnea in infants with trisomy 18.

    Taira R, Inoue H, Sawano T, et al.

    Developmental medicine and child neurology 2020; (62(7)):874-878 doi:10.1111/dmcn.14403.

    PMID: 31763690
  5. 5

    Apneas observed in trisomy 18 neonates should be differentiated from epileptic apneas.

    Fukasawa T, Kubota T, Tanaka M, et al.

    American journal of medical genetics. Part A 2015; (167A(3)):602-6 doi:10.1002/ajmg.a.36929.

    PMID: 25691412
  6. 6

    Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome.

    Bitners AC, Arens R

    Lung 2020; (198(2)):257-270 doi:10.1007/s00408-020-00342-5.

    PMID: 32166426
  7. 7

    [Overnight polysomnography versus respiratory polygraphy in the diagnosis of pediatric obstructive sleep apnea].

    Franco P, Bourdin H, Braun F, et al.

    Archives de pediatrie : organe officiel de la Societe francaise de pediatrie 2017; (24 Suppl 1()):S16-S27 doi:10.1016/j.arcped.2016.09.050.

    PMID: 27793516
  8. 8

    Airway findings in trisomy 13 and trisomy 18: A 10-year retrospective review.

    Dress C, Silva CT, von Allmen DC, Zak S

    Pediatric pulmonology 2024; (59(2)):342-347 doi:10.1002/ppul.26750.

    PMID: 37937891
  9. 9

    Otolaryngologic Manifestations of Trisomy 13 and Trisomy 18 in Pediatric Patients.

    Benson J, Stewart C, Kenna MA, Shearer AE

    The Laryngoscope 2023; (133(6)):1501-1506 doi:10.1002/lary.30350.

    PMID: 37158261
  10. 10

    Causes of death in individuals with trisomy 18 after the first year of life.

    Mehl JM, Gelfond J, Carey JC, Cody JD

    American journal of medical genetics. Part A 2024; (194(2)):279-287 doi:10.1002/ajmg.a.63436.

    PMID: 37822198
  11. 11

    Medical procedures and outcomes of Japanese patients with trisomy 18 or trisomy 13: analysis of a nationwide administrative database of hospitalized patients.

    Ishitsuka K, Matsui H, Michihata N, et al.

    American journal of medical genetics. Part A 2015; (167A(8)):1816-21 doi:10.1002/ajmg.a.37104.

    PMID: 25847518
  12. 12

    Treatment Options for Pediatric Obstructive Sleep Apnea.

    Cielo CM, Gungor A

    Current problems in pediatric and adolescent health care 2016; (46(1)):27-33.

    PMID: 26597557
  13. 13

    Continuous positive airway pressure for obstructive sleep apnea in children.

    Wang JJ, Imamura T, Lee J, et al.

    Canadian family physician Medecin de famille canadien 2021; (67(1)):21-23 doi:10.46747/cfp.670121.

    PMID: 33483390
  14. 14

    Non-invasive Ventilation and CPAP Failure in Children and Indications for Invasive Ventilation.

    Amaddeo A, Khirani S, Griffon L, et al.

    Frontiers in pediatrics 2020; (8()):544921 doi:10.3389/fped.2020.544921.

    PMID: 33194886
  15. 15

    Age and weight considerations for the use of continuous positive airway pressure therapy in pediatric populations: an American Academy of Sleep Medicine position statement.

    Amos L, Afolabi-Brown O, Gault D, et al.

    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2022; (18(8)):2041-2043 doi:10.5664/jcsm.10098.

    PMID: 35638127
  16. 16

    Home High-Flow Nasal Cannula Therapy in Children with Congenital Heart Disease.

    Hanaki Y, Muneuchi J, Yamamoto J, et al.

    Pediatric cardiology 2022; (43(5)):1131-1135 doi:10.1007/s00246-022-02834-y.

    PMID: 35099569
  17. 17

    Role of Nasopharyngeal Airway in Management of Craniofacial Syndrome-Associated Upper Airway Obstruction in Children.

    Thambar S, Wong MD, Schilling S, Kapur N

    Orthodontics & craniofacial research 2026; (29(3)):463-468 doi:10.1111/ocr.12872.

    PMID: 39503249
  18. 18

    High flow nasal cannula treatment for obstructive sleep apnea in infants and young children.

    Ignatiuk D, Schaer B, McGinley B

    Pediatric pulmonology 2020; (55(10)):2791-2798 doi:10.1002/ppul.25009.

    PMID: 32786142
  19. 19

    Polysomnographic parameters and clinical risk factors predicting postoperative respiratory complications in children undergoing supraglottoplasty.

    Kanavitoon S, Ngamprasertwong P, Gurbani N, et al.

    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2024; (20(1)):9-16 doi:10.5664/jcsm.10770.

    PMID: 37584453
  20. 20

    Otolaryngologic surgery in children with trisomy 18 and 13.

    Karimnejad K, Costa DJ

    International journal of pediatric otorhinolaryngology 2015; (79(11)):1831-3.

    PMID: 26375930
  21. 21

    Managing the Child with Persistent Sleep Apnea.

    Bluher AE, Ishman SL, Baldassari CM

    Otolaryngologic clinics of North America 2019; (52(5)):891-901 doi:10.1016/j.otc.2019.06.004.

    PMID: 31301824
  22. 22

    Characteristics and outcomes of interventions for pediatric laryngomalacia: A systematic review with meta-analysis.

    Mills JF, Monaghan NP, Nguyen SA, et al.

    International journal of pediatric otorhinolaryngology 2024; (178()):111896 doi:10.1016/j.ijporl.2024.111896.

    PMID: 38364547
  23. 23

    A novel technique for unilateral supraglottoplasty.

    Ching HH, Spinner AG, Reeve NH, O-Lee TJ

    International journal of pediatric otorhinolaryngology 2018; (104()):150-154 doi:10.1016/j.ijporl.2017.11.003.

    PMID: 29287857
  24. 24

    Disagreement About Surgical Intervention in Trisomy 18.

    Kochan M, Cho E, Mercurio M, et al.

    Pediatrics 2021; (147(1)) doi:10.1542/peds.2020-010686.

    PMID: 33298466
  25. 25

    Post-Tracheostomy Fistula Formation Between the Trachea and Left Common Carotid Artery in a Pediatric Patient with Trisomy 18.

    Shiina T, Watanabe H, Yoshimoto J, et al.

    Acta medica Okayama 2026; (80(4)):247-252 doi:10.18926/AMO/71068.

    PMID: 42633995
  26. 26

    Dual Airway Compromise From Infantile Hemangioma and Laryngomalacia: Fatal Airway Obstruction Following Self-Extubation.

    Cha G, Cohle S

    The American journal of forensic medicine and pathology 2026; (47(1)):92-94 doi:10.1097/PAF.0000000000001076.

    PMID: 41060017
  27. 27

    Home mechanical ventilation in Canada: a national survey.

    Rose L, McKim DA, Katz SL, et al.

    Respiratory care 2015; (60(5)):695-704 doi:10.4187/respcare.03609.

    PMID: 25587173
  28. 28

    Home Oxygen Use and Post-Discharge Management of Infants with Bronchopulmonary Dysplasia.

    Dawson S, Berlin K, Brewer B, Lagatta J

    Clinics in perinatology 2026; (53(2)):263-275 doi:10.1016/j.clp.2026.02.009.

    PMID: 42276720
  29. 29

    Alarms in Long-Term Home Mechanical Ventilation.

    Khirani S, Bokov P, Leroux K, et al.

    Respiratory care 2026; 19433654261450539 doi:10.1177/19433654261450539.

    PMID: 42206696
  30. 30

    Mask interfaces and devices for home noninvasive ventilation in children.

    Khirani S, Ducrot V

    Pediatric pulmonology 2024; (59(6)):1528-1540 doi:10.1002/ppul.26984.

    PMID: 38546008
  31. 31

    Acute Healthcare Utilization During the First Year After Hospital Discharge in Children With Trisomy 18.

    Matsushima A, Iwatani S, Matsui S, Yoshimoto S

    American journal of medical genetics. Part A 2026; doi:10.1002/ajmg.a.70309.

    PMID: 42764676
  32. 32

    Clinical Course for Patients With Trisomy 13 and 18 Pursuing Life-Prolonging Therapies Versus Comfort-Directed Care.

    Milligan MCP, Jackson LE, Maurer SH

    The American journal of hospice & palliative care 2021; (38(10)):1225-1229 doi:10.1177/1049909120985210.

    PMID: 33375814
  33. 33

    Structured Framework for Multidisciplinary Parent Counseling and Medical Interventions for Fetuses and Infants with Trisomy 13 or Trisomy 18.

    Kim AJH, Marshall M, Gievers L, et al.

    American journal of perinatology 2024; (41(S 01)):e2666-e2673 doi:10.1055/s-0043-1772748.

    PMID: 37619598
  34. 34

    Trisomy 18-when the diagnosis is compatible with life.

    Silva C, Ferreira MC, Saraiva J, Cancelinha C

    European journal of pediatrics 2022; (181(7)):2809-2819 doi:10.1007/s00431-022-04477-w.

    PMID: 35522316
  35. 35

    Transitions in Care for Infants with Trisomy 13 or 18.

    Patterson J, Taylor G, Smith M, et al.

    American journal of perinatology 2017; (34(9)):887-894 doi:10.1055/s-0037-1600912.

    PMID: 28301894

This page is for informational purposes only and does not constitute medical advice about a child with trisomy 18. The child's pediatric airway team must tailor testing, equipment settings, surgery, and emergency planning to the child's needs.