Findings of polycythaemia or compensatory metabolic alkalosis support the diagnosis of OSAHS but are frequently absent in paediatric patients Right ventricular hypertrophy on electrocardiography, or dysfunction on echocardiogram, are seen only in the more severe cases Radiographic evaluations are helpful, but are often done awake, upright or with the child sedated for the procedure and do not reliably predict the presence or severity of upper airway obstruction when the child is supine and asleep A lateral soft tissue radiograph of the neck can identify tonsillar and adenoid tissue MRI, CT scan of the airway and craniofacial anatomy, airway fl uoroscopy or endoscopy and cephalometric radiographs can display airway dimensions, dynamics and abnormal structural relationships