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Evolution of Obstructive Sleep Apnea in Infants with Cleft Palate and Micrognathia
Christopher M Cielo1, Jesse A Taylor2, Arastoo Vossough3
1Sleep Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Insights
Infants with micrognathia have significantly higher obstructive sleep apnea (OSA) than controls. Craniofacial anomalies like micrognathia and midface hypoplasia predict OSA severity, which often improves with growth or surgery.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Craniofacial Surgery
Background:
- Children with craniofacial anomalies face a high risk of obstructive sleep apnea (OSA).
- Prevalence and structural predictors of OSA in this population remain largely unknown.
- Understanding these factors is crucial for timely diagnosis and intervention.
Purpose of the Study:
- To investigate the prevalence and structural predictors of OSA in infants with craniofacial anomalies.
- To compare OSA severity in infants with micrognathia versus isolated cleft palate (ICP) and controls.
- To determine correlations between OSA severity, mandibular size, neurodevelopment, and growth.
Main Methods:
- A prospective cohort study involving 15 infants with ICP, 19 with micrognathia, and 9 controls.
- Polysomnography, neurodevelopmental testing, and cephalometrics were performed at baseline and 6-month follow-up.
- Statistical analyses compared OSA severity (apnea-hypopnea index) and correlated structural measures with OSA outcomes.
Main Results:
- Infants with micrognathia exhibited significantly higher OSA severity (median AHI 20.1) compared to ICP (3.2) and controls (3.1).
- Cephalometric measures indicated that both midface hypoplasia and micrognathia correlated with OSA severity.
- Neurodevelopmental outcomes were similar across groups, and OSA generally improved with growth or surgical intervention.
Conclusions:
- Micrognathia is significantly associated with more severe OSA in infants, unlike isolated cleft palate.
- Both midface and mandibular hypoplasia are key contributors to OSA in these pediatric populations.
- Surgical correction improved OSA in micrognathia infants, while ICP-related OSA improved with growth.
Study Objectives:
Children with craniofacial anomalies are a heterogeneous group at high risk for obstructive sleep apnea (OSA). However, the prevalence and structural predictors of OSA in this population are unknown. We hypothesized that infants with micrognathia would have more significant OSA than those with isolated cleft palate ± cleft lip (ICP), and those with ICP would have more significant OSA than controls. We postulated that OSA severity would correlate with reduced mandibular size, neurodevelopmental scores, and growth.
Methods:
Prospective cohort study. 15 infants with ICP, 19 with micrognathia, and 9 controls were recruited for polysomnograms, neurodevelopmental testing, cephalometrics (ICP and micrognathia groups) at baseline and a follow-up at 6 mo.
Results:
Baseline apnea-hypopnea index (AHI) [median (range)] of the micrognathia group [20.1 events/h (0.8, 54.7)] was greater than ICP [3.2 (0.3, 30.7)] or controls [3.1 (0.5, 23.3)] (p = 0.001). Polysomnographic findings were similar between ICP and controls. Controls had a greater AHI than previously reported in the literature. Cephalometric measures of both midface hypoplasia and micrognathia correlated with OSA severity. Neurodevelopment was similar among groups. OSA improved with growth in participants with ICP and postoperatively in infants with micrognathia.
Conclusions:
Micrognathia, but not ICP, was associated with more significant OSA compared to controls. Both midface and mandibular hypoplasia contribute to OSA in these populations. OSA improved after surgical correction in most infants with micrognathia, and improved without intervention before palate repair in infants with ICP.
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