While OSA is relatively uncommon in children within the general population, those with DS are at a very high risk for developing the disorder due to their specific anatomy. Some of the factors that lead to this higher incidence include the flattened midface, a large tongue, low muscle tone in the mouth and airway, and enlargement of the adenoids and tonsils, according to the NDSS. Furthermore, the incidence of OSA only increases with age, as evidenced in a 2009 study for the Journal of Clinical Sleep Medicine. The study found that adults with Down Syndrome frequently have obstructive sleep apnea. However, because the complications of untreated sleep apnea, such as cardiovascular disease and impaired cognitive function, often overlapped with those already associated with Down syndrome, incidences of OSA in adults with Down syndrome often went unreported. Similarly, a 2006 study for the American Medical Association found many children with DS to have OSA even when their parents did not report abnormal sleep patterns. As such, every effort should be made to recognize the signs of OSA so that it can be diagnosed and treated before serious complications arise.