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Method of Studying Palatal Fusion using Static Organ Culture
Published on: September 19, 2015
Polysomnogram Findings and Psychosocial and Academic Concerns in Children With Cleft Palate With or Without Cleft Lip
Eric Riklin1, Dylan G Choi2, Collean Trotter2
1Behavioral Health Institute, Children's Hospital Los Angeles.
Insights
Children with cleft palate (CP±L) often have sleep apnea (OSA), impacting academic and psychosocial well-being. Early monitoring and treatment of sleep issues are crucial for these children.
Area of Science:
- Pediatric Sleep Medicine
- Craniofacial Anomalies
- Developmental Psychology
Background:
- Children with cleft palate with or without cleft lip (CP±L) face increased risks for sleep-disordered breathing, including obstructive sleep apnea (OSA).
- The combined impact of CP±L and OSA on psychosocial and academic outcomes is not well understood.
- Primary palatoplasty is a common surgical intervention for CP±L.
Purpose of the Study:
- To investigate polysomnography findings in children with isolated (iCP±L) and syndrome-associated (sCP±L) clefts post-palatoplasty.
- To describe the prevalence of psychosocial and academic concerns in these children.
- To explore the relationship between sleep-disordered breathing and these concerns.
Main Methods:
- Retrospective review of medical records (2004-2022) for 694 patients with CP±L undergoing primary palatoplasty.
- Analysis of polysomnography results for 147 patients, with follow-up polysomnograms for 82.
- Collection of demographic, medical history, and family-reported psychosocial and academic data.
Main Results:
- A significant percentage of participants (73-81%) did not have normal polysomnograms, with mild OSA being the most frequent finding (30-35%).
- In iCP±L, oxygen desaturations correlated with special education services and academic concerns; OSA was linked to mental health service history.
- sCP±L patients exhibited higher Obstructive Apnea-Hypopnea Index scores and more frequent all-day special education placements compared to iCP±L patients.
Conclusions:
- Children with CP±L frequently exhibit abnormal sleep study results, often indicative of OSA.
- Sleep-disordered breathing in children with iCP±L is associated with academic and psychosocial challenges.
- Syndrome-associated CP±L presents with more severe sleep apnea and greater educational support needs.
- Cleft care providers should actively screen for and manage sleep concerns, collaborating with specialists and addressing associated psychosocial and academic issues.
Abstract:
Children born with a cleft palate with or without a cleft lip (CP±L) are at risk for sleep-disordered breathing, particularly obstructive sleep apnea (OSA). While OSA and CP±L have both been associated with higher risk for psychosocial and academic concerns, their combined risk has been understudied. This paper aimed to describe polysomnography findings and psychosocial and academic concerns among children with isolated (iCP±L) and syndrome-associated (sCP±L) clefts who had undergone primary palatoplasty. Medical records were reviewed from 2004 to 2022 for demographics, medical history, polysomnography results, and family-reported psychosocial and academic variables. Of the 694 patients with CP±L who had a palatoplasty, 147 had a polysomnogram and 82 had at least one follow-up polysomnogram. Across time points, only 19% to 27% of participants had normal polysomnograms and the most frequent finding was mild OSA for 30% to 35% of patients. For children with iCP±L, more frequent oxygen desaturations were significantly associated with receiving special education services and family-reported academic concerns and OSA was associated with a history of receiving mental health services. Children with sCP±L had a significantly higher Obstructive Apnea-Hypopnea Index and a greater proportion of all-day special education classroom placements relative to youth with iCP±L. Study results suggest that cleft providers should monitor for OSA and sleep-disordered breathing symptoms, collaborate with pulmonologists for evaluation and treatment of sleep concerns, and address possible sleep-associated psychosocial and academic issues.
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