Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate

2014 ◽  
Vol 67 (11) ◽  
pp. 1475-1480 ◽  
Author(s):  
Jason Silvestre ◽  
Youssef Tahiri ◽  
J. Thomas Paliga ◽  
Jesse A. Taylor
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Obstructive Sleep

Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

2019 ◽  
Vol 4 (5) ◽  
pp. 878-892
Author(s):  
Joseph A. Napoli ◽  
Linda D. Vallino
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
A Priori ◽  
Sufficient Evidence ◽  
Obstructive Sleep ◽  
Before And After ◽  
Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

scholarly journals Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate

2014 ◽  
Vol 22 (4) ◽  
pp. 259-263 ◽  
Author(s):  
Jason Silvestre ◽  
Youssef Tahiri ◽  
J Thomas Paliga ◽  
Jesse A Taylor
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Obstructive Sleep

Prevalence and Risk Factors for Obstructive Sleep Apnea Syndrome Among Children and Adolescents with Cleft lip and Palate: A Survey Study in Hong Kong

2021 ◽  
pp. 105566562110683
Author(s):  
A. C. H. Ho ◽  
F. Savoldi ◽  
R. W. K. Wong ◽  
S. C. Fung ◽  
S. K. Y. Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Hong Kong ◽  
Sleep Apnea ◽  
Children And Adolescents ◽  
Cleft Lip ◽  
Sleep Apnea Syndrome ◽  
Survey Study ◽  
Obstructive Sleep ◽  
Secondary Palate

Objective To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). Design Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). Settings Multicenter study in two public hospitals. Patients A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. Main Outcome Measure Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. Results A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p = .034), had cleft involving embryonic secondary palate (PSQ-22, p = .009), and history of fixed orthodontic treatment (ESS, p = .002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p = .015). Conclusions OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment.

Septoplasty for Obstructive Sleep Apnea in Infants after Cleft Lip Repair

1996 ◽  
Vol 33 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Gary D. Josephson ◽  
Jamie Levine ◽  
Court B. Cutting
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Septum ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Septal Deviation ◽  
Facial Growth ◽  
Deviated Nasal Septum ◽  
Obstructive Sleep ◽  
Cleft Lip Repair

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study

2018 ◽  
Vol 56 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Marilyse de Bragança Lopes Fernandes ◽  
Alícia Graziela Noronha Silva Salgueiro ◽  
Eliete Janaína Bueno Bighetti ◽  
Ivy Kiemle Trindade-Suedam ◽  
Inge Elly Kiemle Trindade
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nasal Obstruction ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Pediatric Population ◽  
Care Center ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Obstructive Sleep

Objective: To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate. Design: Prospective cross-sectional study. Setting: Referral care center. Participants: One hundred seventy-four children aged 6 to 12 years of both genders. Interventions: Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance. Results: Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis. Conclusions: Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.

Obstructive Sleep Apnea and Sleep Position: Does It Matter for Infants With a Cleft Palate?

2018 ◽  
Vol 56 (7) ◽  
pp. 890-895 ◽  
Author(s):  
Christopher J. Greenlee ◽  
Melissa A. Scholes ◽  
Dexiang Gao ◽  
Norman R. Friedman
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Sudden Infant Death ◽  
Apnea Hypopnea Index ◽  
Sudden Infant ◽  
Obstructive Sleep

Objective:To determine whether nonsupine sleep improves obstructive sleep apnea (OSA) in infants with cleft palate undergoing polysomnography (PSG).Design:Retrospective chart review.Setting:Tertiary care pediatric hospital.Patients:Twenty-seven infants (1 month to 1 year) with cleft palate with or without cleft lip (CP ± L) undergoing PSG testing for suspected OSA were included.Main Outcome Measures:Polysomnography measures included obstructive apnea–hypopnea index (OAHI), central apnea–hypopnea index (CAHI), oxygen saturation (SpO2) nadir, SpO2, and end-tidal carbon dioxide (ETCO2).Results:Twenty-three PSGs with at least 20 minutes of sleep in both the supine and the nonsupine positions were analyzed. The supine OAHI (mean: 16.8 events/hour; standard deviation [SD]: 18.5) and nonsupine OAHI (mean: 12.6 events/hour; SD: 12.6) did not differ significantly ( P = .10). The supine CAHI (mean: 1.9 events/hour; SD: 2.7) and nonsupine CAHI (mean: 3.1 events/hour; SD: 3.7; P = .15), the supine SpO2nadir (mean: 81.2%; SD: 6.3) and nonsupine SpO2nadir (mean: 81.8%; SD: 5.3; P = .70), the supine mean SpO2(mean: 95.5%; SD: 1.9) and nonsupine mean SpO2saturation (mean: 95.3%; SD: 2.4; P = .34), and the supine ETCO2(mean: 45.4 mm Hg; SD: 5.3) and nonsupine ETCO2(mean: 42.5 mm Hg; SD: 10.1; P = .24) were also similar.Conclusions:There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP ± L. Prior to recommending nonsupine positioning which increases infant’s exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.

Comparison of Positive Screening for Obstructive Sleep Apnea in Patients With and Without Cleft Lip and Palate

2019 ◽  
Vol 57 (3) ◽  
pp. 364-370
Author(s):  
Hande Gorucu-Coskuner ◽  
Banu Saglam-Aydinatay ◽  
Muge Aksu ◽  
Fatma Figen Ozgur ◽  
Tulin Taner
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Breast Feeding ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Bottle Feeding ◽  
Control Group ◽  
Feeding Duration ◽  
Obstructive Sleep ◽  
Cleft Lip Palate

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).

Screening for Obstructive Sleep Apnea in Preschool Children with Cleft Palate

2009 ◽  
Vol 46 (2) ◽  
pp. 117-123 ◽  
Author(s):  
J. E. MacLean ◽  
K. Waters ◽  
D. Fitzsimons ◽  
P. Hayward ◽  
D. A. Fitzgerald
Keyword(s):  
Risk Factors ◽  
Obstructive Sleep Apnea ◽  
Risk Factor ◽  
Preschool Children ◽  
Sleep Apnea ◽  
Cleft Lip ◽  
Clinical Risk Factor ◽  
Questionnaire Data ◽  
Clinical Risk ◽  
Obstructive Sleep

Objective: The objective of this study was to explore the prevalence, range of reported symptoms, and clinical risk factors of obstructive sleep apnea in preschool children with cleft lip and/or palate. Design: Questionnaires were distributed to parents/guardians of all children from birth to 5 years of age who were followed by the cleft clinic. Results: Questionnaire data and cleft classification were available for 248 children, with a mean age of 33.4 months. Obstructive sleep apnea was identified in 31.4% of the children. Only 29.5% of children with obstructive sleep apnea had undergone an investigation of these symptoms. The three most common symptoms reported in children with a questionnaire diagnosis of obstructive sleep apnea were (1) “heavy or loud breathing,” (2) “easily distracted,” and (3) “on the go” or “driven by a motor.” The only clinical risk factor associated with a questionnaire diagnosis of obstructive sleep apnea was the presence of a syndrome (χ2  =  3.5, p  =  .05). There were no significant differences in risk of obstructive sleep apnea by age, cleft classification, and surgical status. Conclusion: Preschool children with cleft lip and/or palate have a risk of obstructive sleep apnea that is as much as five times that of children without cleft. Obstructive sleep apnea appears to be underrecognized in this group of children. Further research is needed to investigate important risk factors for obstructive sleep apnea in children with cleft lip and/or palate.

Craniofacial, Craniocervical, and Pharyngeal Morphology in Bilateral Cleft Lip and Palate and Obstructive Sleep Apnea Patients

2007 ◽  
Vol 44 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Barbara C. M. Oosterkamp ◽  
Hendrik J. Remmelink ◽  
Gerard J. Pruim ◽  
Aarnoud Hoekema ◽  
Pieter U. Dijkstra
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Hyoid Bone ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Reference Group ◽  
Obstructive Sleep ◽  
Lateral Cephalograms ◽  
Bilateral Cleft Lip

Objective: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. Subjects and methods: Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance. Results: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group. Conclusions: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.

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