Down syndrome continues to be the most common chromosomal condition,1,2 with rising prevalence and increased survival. An estimated 1 in 700 infants are born with Down syndrome in the US each year; the median life span is 57 years, with reported survival up to age 82 years.2,3 Improved childhood survival is credited to advances in surgery for congenital heart disease, management of respiratory illness, and decreased institutionalization. Mortality after age 20 years is associated with disorders of the cardiovascular and respiratory systems, with severity of the level of intellectual disability, dementia, and mobility restrictions as important risk factors.3,4