The Effect of Cleft Palate Repair on Polysomnography Results

Abstract

Study Objectives: In view of the risk that surgical repair of cleft palate may induce or worsen obstructive sleep apnea (OSA), the goal of this study was to assess presurgical and postsurgical polysomnography (PSG) results for children who underwent primary palatoplasty. Methods: Retrospective case-control series for children with cleft palate repair performed between January 2008 and December 2016 at a tertiary pediatric center. Children underwent PSG before and after surgery. Results: Sixty-four children (53.1% female) with a mean age of 2.0 ± 2.8 years (range 0.6-16.4) were included in the study. Pierre-Robin sequence was the most common comorbidity (67%). Before palatal repair, the mean obstructive apnea-hypopnea index (oAHI) was 3.4 ± 3.9 (range 0-17.9) events/h; this did not significantly change, with 5.9 ± 14.5 (range 0-105.7) events/h after surgery (P = 0.30). However, 34.4% of patients had a worsening of more than 1 obstructive event/h and 18.9% had a worsening of 5 or more obstructive events/h. The presence of a concomitant syndrome (eg, Treacher Collins) was a risk factor for postoperative OSA (odds ratio 4.2, 95% confidence interval 1.1-15.8, P = .03) Conclusions: OSA did not develop or worsen following primary palatoplasty. However, the oAHI increased by 5 or more events/h in approximately 20% of study participants. The presence of a syndrome was the only factor predictive of worsening OSA after palatoplasty. These findings suggest that palatoplasty does not worsen or cause OSA in most patients, and that nonsyndromic children are at low risk for the development or worsening of OSA.

Cleft Palate Repair in Robin Sequence following Mandibular Distraction Osteogenesis Compared to Tongue-Lip Adhesion

“…Interestingly, MDO was associated with earlier timing of palatoplasty without an increase in perioperative complications or events. Additionally, regardless of surgical airway intervention, sleep respiratory parameters as reported on polysomnogram improved significantly after treatment and did not diminish after palatoplasty as others have reported, but rather further improved in those who underwent MDO (Bergeron et al, 2019).…”

Evaluation and diagnosis of pediatric obstructive sleep apnea—An update

“…Other special populations include children with cleft palate, in whom the underdevelopment and unusual orientation of the palatal musculature increase the propensity for airway collapse (Robison and Otteson, 2011;Muntz, 2012). Surgical procedures designed to repair these anatomic problems are also associated with a higher risk of postoperative upper airway obstruction, requiring a high degree of vigilance following surgery (Rose et al, 2002;Bergeron et al, 2019).…”

Furlow Palatoplasty, Nasopharyngeal Size, and Sleep Oximetry

“…In a recent study, Bergeron and his colleagues have found that primary palatoplasty did not cause or worsen OSA in most cases. In 20% of their patients, some worsening occurred and the presence of an associated syndrome was the only predictive factor (Bergeron et al, 2019).…”