Sleep Disordered Breathing and Obstructive Sleep Apnea in the Cleft Population

Objectives/hypothesis: Children with cleft deformities have the tendency for multilevel airway obstruction. The incidence of sleep disordered breathing (SDB) in this population has not been well studied. This study attempts to describe the high incidence and the results of intervention.

Study Design: A three-year retrospective chart review by a tertiary cleft and craniofacial team.

Methods: The symptoms of sleep disordered breathing and polysomnographic data were reviewed and analyzed using descriptive statistics and multivariate analysis.

Results: Of the 539 children seen during the period, 120 (22%) had symptoms suggestive of SDB. Twenty-four of them had a tonsillectomy with or without partial adenoidectomy without polysomnogram (PSG). Sixty-nine (57%) had a PSG, and 28 (40%) had a follow-up PSG. Syndromic children had significantly more symptoms of SDB (P < .001) and were more likely to undergo PSG (P < .05). Of those children who underwent a PSG, only six had a normal obstructive apnea-hypopnea index (OAHI) with a mean (+/-standard deviation) respiratory disturbance index (RDI) of 15.5 (+/-17.5) and OAHI of 12.05 (+/-15.57). Post intervention PSG showed significant improvement in RDI (P = .048) and OAHI (P = .012) using a single-tailed Wilcoxan analysis. Unfortunately, most of these children still had significant sleep apnea. There was also a high percentage of children with periodic leg motion syndrome (24.7%), some of whom also had OSA.

Conclusion: There is a high incidence of SDB and definable OSA in the cleft population. Though there is a statistically significant improvement after intervention, some were not cured. Sleep disturbance and OSA is likely under-reported and treated in the cleft population. PSG should be done more frequently, and post intervention PSG should be strongly considered.