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The Effect of Cleft Palate Repair on Polysomnography Results
Mathieu Bergeron1,2, Aliza P Cohen1, Alexandra Maby3
1Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio.
Insights
Primary palatoplasty generally does not worsen obstructive sleep apnea (OSA) in children. However, about 20% of patients experienced a significant increase in apnea events, with syndromic children being at higher risk.
Area of Science:
- Pediatric Surgery
- Sleep Medicine
- Genetics
Background:
- Surgical repair of cleft palate carries a potential risk of inducing or exacerbating obstructive sleep apnea (OSA).
- Assessing the impact of primary palatoplasty on sleep-disordered breathing is crucial for patient management.
Purpose of the Study:
- To evaluate changes in obstructive sleep apnea (OSA) severity following primary palatoplasty in children.
- To identify risk factors associated with worsening OSA after cleft palate repair.
Main Methods:
- Retrospective case-control study of 64 children undergoing primary palatoplasty.
- Polysomnography (PSG) was performed before and after surgical repair.
- Statistical analysis to compare pre- and post-surgical apnea-hypopnea index (AHI) and identify predictors of worsening OSA.
Main Results:
- The overall obstructive apnea-hypopnea index (oAHI) did not significantly change post-surgery (P = 0.30).
- A significant worsening of oAHI (≥5 events/h) occurred in 18.9% of patients.
- Concomitant syndromes, such as Treacher Collins, were identified as a significant risk factor for postoperative OSA (OR 4.2, P = .03).
Conclusions:
- Primary palatoplasty does not typically cause or worsen obstructive sleep apnea (OSA) in the majority of pediatric patients.
- Children with syndromic conditions represent a higher-risk group for OSA exacerbation after palatoplasty.
- Nonsyndromic children undergoing palatoplasty are at low risk for developing or worsening OSA.
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.
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