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Published on: December 6, 2016
Obstructive sleep apnea pretreatment and posttreatment in symptomatic children with congenital craniofacial
Marta Moraleda-Cibrián1,2, Sean P Edwards2, Steven J Kasten3
1Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.
Insights
Obstructive sleep apnea (OSA) is highly prevalent in children with craniofacial malformations (CFM), with many cases being moderate-to-severe. Residual OSA after treatment is common, indicating a need for ongoing evaluation in this population.
Area of Science:
- Pediatric Pulmonology
- Craniofacial Medicine
- Sleep Medicine
Background:
- Obstructive sleep symptoms are frequent in children with craniofacial malformations (CFM).
- Objective data on obstructive sleep apnea (OSA) in this population is limited.
- Children with CFM often present with complex airway challenges.
Purpose of the Study:
- To determine the frequency of OSA in symptomatic children with CFM.
- To assess the severity of OSA in this cohort.
- To evaluate the effectiveness of treatments for OSA in children with CFM.
Main Methods:
- Retrospective review of symptomatic children with CFM undergoing polysomnography (PSG).
- Defined OSA as an apnea/hypopnea index (AHI) ≥ 1; moderate/severe OSA as AHI ≥ 5.
- Analyzed treatment outcomes for positive airway pressure (PAP) and adenotonsillectomy (AT).
Main Results:
- 87% of 151 symptomatic children with CFM were diagnosed with OSA; 24% had moderate-to-severe OSA.
- Syndromic CFM was associated with a higher likelihood of moderate-to-severe OSA (33% vs. 15%).
- PAP therapy showed a trend towards decreased AHI and improved SpO2, while AT did not yield significant improvements.
Conclusions:
- The majority of symptomatic children with CFM exhibit objective evidence of OSA, often moderate-to-severe.
- Many children with CFM may have undiagnosed OSA, necessitating proactive screening.
- Persistent OSA after treatment is a significant concern in children with CFM.
Study Objectives:
Obstructive sleep symptoms are common in children with craniofacial malformations (CFM). However objective data about obstructive sleep apnea (OSA) is still limited. The aims of this study were to investigate the frequency of OSA in symptomatic children with CFM and to determine improvement in severity of OSA after treatment.
Methods:
Symptomatic children with CFM referred for a diagnostic polysomnogram (PSG) were identified. Obstructive sleep apnea was defined as an apnea/hypopnea index (AHI) ≥ 1, with moderate/severe OSA as an AHI ≥ 5.
Results:
Overall, 151 symptomatic children were identified; 87% were diagnosed with OSA, of whom 24% had moderate-to-severe OSA. Children with syndromic CFM, compared to non-syndromic CFM, were more likely to have an AHI ≥ 5 (syndromic 33% vs. non-syndromic 15%, p = 0.02). Of the 131 children with OSA, 64 were treated and 32 returned for a posttreatment PSG, with 22 treated with either positive airway pressure (PAP) or adenotonsillectomy (AT). Children treated with PAP demonstrated a decrease in AHI from 6.2 to 3.5 (p = 0.057) and an increase in SpO2 from 89.1% to 91.1% (p = 0.091). There were no significant improvements for those in the AT group for either AHI (2.5 to 1.8, p = 0.19) or SpO2 (90.4% to 91.3%, p = 0.46). Normalization of the AHI (AHI < 1) occurred in only one child in each group (7% and 14% of the PAP and AT groups, respectively).
Conclusions:
The vast majority of children with CFM referred for OSA evaluation are found to have objective evidence of OSA and a quarter of children have moderate-to-severe OSA. It is likely that many children with underlying OSA are not identified and referred for evaluation. Residual OSA after treatment is common in children with CFM.
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