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Updated: May 11, 2026

Midface Hypoplasia and Cranial Base Morphology in Syndromic Craniosynostosis: A Comparative Analysis Study Using a Predictive Regression Model
Published on: November 4, 2025
How does obstructive sleep apnoea evolve in syndromic craniosynostosis? A prospective cohort study
Caroline Driessen1, Koen F M Joosten, Natalja Bannink
1Department of Plastic, Reconstructive, and Hand Surgery, Dutch Craniofacial Centre, Erasmus Medical Centre--Sophia Children's Hospital, Rotterdam, The Netherlands. c.driessen@erasmusmc.nl
Insights
Obstructive sleep apnoea syndrome (OSAS) is common in children with syndromic craniosynostosis, often improving naturally in the first three years. Early diagnosis is key, as severe OSAS is unlikely to develop later if not present initially.
Area of Science:
- Pediatric Pulmonology
- Craniofacial Surgery
- Sleep Medicine
Background:
- Syndromic craniosynostosis presents unique challenges in pediatric care.
- Obstructive sleep apnoea syndrome (OSAS) is a significant concern in this population.
- Understanding the natural course of OSAS is crucial for timely intervention.
Purpose of the Study:
- To investigate the prevalence and natural history of OSAS in children with syndromic craniosynostosis.
- To identify factors influencing OSAS progression in this cohort.
- To inform clinical management strategies for OSAS in pediatric craniofacial anomalies.
Main Methods:
- Prospective cohort study involving 97 children with syndromic craniosynostosis.
- Level III sleep studies were conducted to assess OSAS severity.
- Longitudinal data analysis using mixed-effects models for untreated patients.
Main Results:
- OSAS prevalence was high at 68% in the studied population.
- The obstructive apnoea-hypopnoea index naturally decreased over time, particularly in the first three years.
- Midface hypoplasia was associated with higher OSAS values and slower improvement.
- Severe OSAS did not develop later in childhood if not present initially.
Conclusions:
- OSAS is highly prevalent in syndromic craniosynostosis and shows some natural improvement.
- Children with Apert or Crouzon/Pfeiffer syndromes experienced less improvement.
- Continuous clinical surveillance is essential for managing OSAS and associated risk factors in these children.
Objective:
To describe the course of obstructive sleep apnoea syndrome (OSAS) in children with syndromic craniosynostosis.
Design:
Prospective cohort study.
Setting:
Dutch Craniofacial Centre from January 2007 to January 2012.
Patients:
A total of 97 children with syndromic craniosynostosis underwent level III sleep study. Patients generally undergo cranial vault remodelling during their first year of life, but OSAS treatment only on indication.
Main Outcome Measures:
Obstructive apnoea-hypopnoea index, the central apnoea index and haemoglobin oxygenation-desaturation index derived from consecutive sleep studies.
Results:
The overall prevalence of OSAS in syndromic craniosynostosis was 68% as defined by level III sleep study. Twenty-three patients were treated for OSAS. Longitudinal profiles were computed for 80 untreated patients using 241 sleep studies. A mixed effects model showed higher values for the patients with midface hypoplasia as compared to those without midface hypoplasia (Omnibus likelihood ratio test=7.9). In paired measurements, the obstructive apnoea-hypopnoea index (Z=-3.4) significantly decreased over time, especially in the first years of life (Z=-3.3), but not in patients with midface hypoplasia (Z=-1.5). No patient developed severe OSAS during follow-up if it was not yet diagnosed during the first sleep study.
Conclusions:
OSAS is highly prevalent in syndromic craniosynostosis. There is some natural improvement, mainly during the first 3 years of life and least in children with Apert or Crouzon/Pfeiffer syndrome. In the absence of other co-morbid risk factors, it is highly unlikely that if severe OSAS is not present early in life it will develop during childhood. Ongoing clinical surveillance is of great importance and continuous monitoring for the development of other co-morbid risk factors for OSAS should be warranted.
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