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Published on: September 19, 2015
Surgical Closure of the Cleft Palate Has a Transient Obstructive Effect on the Upper Airway in Children
Priscila Capelato Prado1, Marilyse de Bragança Lopes Fernandes1, Armando Dos Santos Trettene1
1Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil.
Insights
Palate repair in children with cleft palate can temporarily worsen obstructive sleep apnea (OSA) symptoms like snoring. Long-term snoring suggests ongoing OSA risk in this population, highlighting underappreciated OSA concerns.
Area of Science:
- Pediatric Surgery
- Sleep Medicine
- Craniofacial Anomalies
Background:
- Obstructive sleep apnea (OSA) is a concern in children with cleft palate (CP).
- Primary palatoplasty is a common surgical intervention for CP.
- The impact of palatoplasty on pediatric OSA symptoms requires further investigation.
Purpose of the Study:
- To prospectively evaluate respiratory symptoms associated with OSA after primary palatoplasty in children with CP.
- To compare OSA-related symptoms in children with CP undergoing palatoplasty versus controls with isolated cleft lip (CL).
Main Methods:
- Fifty-six non-syndromic children with CP and 20 with isolated CL were assessed pre- and post-surgery.
- Respiratory symptoms (difficulty breathing, apnea, snoring) were monitored.
- A validated OSA index was used to predict OSA presence at different time points.
Main Results:
- Children with CP showed increased OSA index scores and snoring frequency post-palatoplasty compared to controls.
- These OSA-related symptoms were more pronounced in the early postoperative period.
- No sleep apnea events were reported, but snoring persisted long-term.
Conclusions:
- Primary palatoplasty temporarily increases upper airway obstruction and OSA-related symptoms in children with CP.
- Persistent snoring indicates a long-term risk for OSA in this population.
- OSA is likely underdiagnosed and underappreciated in children with cleft palate.
Objective:
To prospectively investigate the occurrence of respiratory symptoms related to obstructive sleep apnea (OSA) following primary palatoplasty in children with cleft palate (CP).
Method:
Fifty-six nonsyndromic children presenting CP with a previously repaired cleft lip (CL) or without CL were assessed before and after palate repair. Twenty nonsyndromic children with isolated CL were analyzed as controls before and after lip repair. Respiratory symptoms were investigated preoperatively, and at early and late postoperative periods. Based on the parent reports of "difficulty of breathing (D), apnea events (A) and/or snoring (S) during sleep, a validated OSA index (1.42D + 1.41A + 0.71S - 3.83) was used to predict absence of OSA, possible OSA, and presence of OSA, at the 3 periods analyzed.
Results:
Screening for OSA showed that the CP group exhibited an increased mean index at the early postoperative assessment, suggesting "possible OSA," and a higher frequency of snoring at the early and late postoperative assessments, as compared to the CL group (P < .05). Sleep apnea events were not reported.
Conclusions:
Surgical closure of the palate has an obstructive effect on the upper airway in the short term, causing OSA-related respiratory symptoms, mostly transient. However, the high prevalence of snoring still observed in the long term indicate that children with a palatal cleft who undergo surgical repair are at risk for OSA. The results support the conclusion that OSA is underappreciated in this population.
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