Clinical Research Fellow Medical University of South Carolina
Introduction: Prior research suggests that children with cleft palate (CP) are at increased risk of obstructive sleep-disordered breathing (SDB). However, few studies differentiate the effects of CP repair on SDB based on syndrome status. The goal of this study was to evaluate differences in SDB after palatoplasty among children with non-syndromic cleft palate (NsCP), those with syndromic cleft palate (sCP), and isolated Pierre Robin Sequence (PRS).
Methods: A retrospective case series with chart review was performed for children who underwent primary CP repair at a tertiary children’s hospital from 2014 to 2021. Demographics, type of CP, and SDB symptoms were collected. NsCP included children with no anomalies, and sCP included children with PRS and children with syndromes. Multivariate logistic regression was performed to determine predictors for the presence of SDB as defined by parent-reported symptoms or evidence of obstructive sleep apnea (OSA) on PSG after palatoplasty.
Results: A total of 152 infants met inclusion criteria. Median age at palatoplasty was 11.0 [IQR 10.1 - 13.7] months and included 73 (48.0%) male patients. Most patients (61.8%) had NsCP. There were 41 (27.0%) children with a specific genetic syndrome and 17 (11.2%) with PRS. Of the children with PRS, nine (53.0%) underwent mandibular distraction osteogenesis at a mean 10.7 ± 1.5 months before palatoplasty. Children with NsCP had fewer SDB symptoms (27 [28.7%] vs. 29 [50.0%], p=0.008), postoperative PSG studies (8 [8.5%] vs. 15 [25.9%], p=0.004), and lower rates of OSA postoperatively (5 [62.5%] vs. 15 [100.0%], p=0.011) compared to sCP children after palatoplasty. Controlling for age, sex, and type of CP, a child with a syndrome or PRS was nearly 3 to 4 times more likely to have SDB than a child with NsCP after palatoplasty (adjusted odds ratio [aOR] 2.92, 95% CI 1.33-6.43, p=0.008 and aOR 4.13, 95% CI 1.32-12.98, p=0.015, respectively).
Conclusion: These results suggest that while many children with CP may demonstrate SDB after palatoplasty, those with a syndrome or PRS were at greater risk than children with a NsCP. Clinicians should counsel parents preoperatively and closely monitor these populations for obstructive sleep symptoms after palate repair.