Longitudinal Follow-Up of Obstructive Sleep Apnea following Furlow Palatoplasty in Children with Cleft Palate: A Preliminary Report

Objective To longitudinally investigate the incidence and severity of obstructive sleep apnea (OSA) following Furlow palatoplasty for velopharyngeal insufficiency (VPI) in children with cleft palate. Subjects Ten children, six boys and four girls, mean age 5.1 years, at Furlow palatoplasty. Design Prospective analysis. Main Outcome Measures Overnight polysomnographic studies were used to determine the incidence and severity of sleep apneas 1 day prior to Furlow palatoplasty, 1 week postoperatively, and approximately 3 and 6 months postoperatively. Results None of the patients suffered OSA prior to Furlow palatoplasty. A high incidence of mild OSA (100%) occurred during the early postoperative period (p < .001) but resolved within 3 months in all but two patients (20%). Only one OSA (10%) persisted 6 months postoperatively. Conclusions Furlow palatoplasty for VPI in children with cleft palate might induce temporary and mild OSA.

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Longitudinal Follow-Up of Obstructive Sleep Apnea Following Furlow Palatoplasty in Children With Cleft Palate: A Preliminary Report

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569(2003)040<0269:lfoosa>2.0.co;2 ◽

2003 ◽

Vol 40 (3) ◽

pp. 269-273 ◽

Cited By ~ 12

Author(s):

Yu-Fang Liao ◽

Claudia Yun ◽

Chiung-Shing Huang ◽

Philip K. T. Chen ◽

Ning-Hung Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Preliminary Report ◽

Obstructive Sleep

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Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

International Journal of Otolaryngology ◽

10.1155/2012/912767 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

L. M. Paulson ◽

C. J. MacArthur ◽

K. B. Beaulieu ◽

J. H. Brockman ◽

H. A. Milczuk

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Speech Intelligibility ◽

Velopharyngeal Insufficiency ◽

Speech Evaluation ◽

Obstructive Sleep ◽

Significant Difference ◽

Before And After ◽

History Of

Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI), particularly in those with cleft palate.Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance.Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87%) had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48%) and staged tonsillectomy prior to pharyngoplasty in 10 (43%). There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population.Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

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Comparison of Obstructive Sleep Apnea Syndrome in Children with Cleft Palate following Furlow Palatoplasty or Pharyngeal Flap for Velopharyngeal Insufficiency

The Cleft Palate-Craniofacial Journal ◽

10.1597/02-162 ◽

2004 ◽

Vol 41 (2) ◽

pp. 152-156 ◽

Cited By ~ 52

Author(s):

Yu-Fang Liao ◽

M. Samuel Noordhoff ◽

Chiung-Shing Huang ◽

Philip K. T. Chen ◽

Ning-Hung Chen ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Palate ◽

Obstructive Sleep Apnea Syndrome ◽

Sleep Apnea Syndrome ◽

Velopharyngeal Insufficiency ◽

Obstructive Sleep ◽

The Mean ◽

Pharyngeal Flap ◽

Apnea Syndrome

Objective To evaluate the incidence and severity of obstructive sleep apnea syndrome (OSAS) in patients with cleft palate having a Furlow palatoplasty or pharyngeal flap for correction of velopharyngeal insufficiency (VPI). Patients A total of 48 nonsyndromic children with repaired cleft palate with VPI were enrolled in the study. Twenty of the children had a Furlow palatoplasty (F group) and 28 children had a pharyngeal flap (P group) for correction of VPI. Interventions An overnight polysomnography evaluation was done to evaluate the incidence and severity of OSAS 6 months or more postoperatively. Main Outcome Measures Symptoms of OSAS, respiratory disturbance index (RDI), oxyhemoglobin desaturation index (DI), and sleep stages were measured. Results In the P group, the mean percentage of stage 2 sleep was lower than the F group (p < .05). The mean RDI and DI were larger in the P group, compared with the F group (p < .001). The incidence and severity of OSAS were higher in the P group, compared with the F group (p < .001 and p = 0.05, respectively). Conclusions A Furlow palatoplasty should be used in deference to a pharyngeal flap whenever possible on the basis of the preoperative evaluation of VPI because of the decreased incidence and severity of OSAS.

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Improvement in Obstructive Sleep Apnea (OSA) in Super Morbidly Obese Patients After Bariatric Surgery

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2020.08.10650 ◽

2020 ◽

Vol 103 (8) ◽

pp. 725-728

Keyword(s):

Bariatric Surgery ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Lifestyle Modification ◽

Apnea Hypopnea Index ◽

Morbidly Obese ◽

Obese Patients ◽

Obstructive Sleep ◽

Objective Evidence

Background: Lifestyle modification is the mainstay therapy for obese patients with obstructive sleep apnea (OSA). However, most of these patients are unable to lose the necessary weight, and bariatric surgery (BS) has been proven to be an effective modality in selected cases. Objective: To provide objective evidence that BS can improve OSA severity. Materials and Methods: A prospective study was conducted in super morbidly obese patients (body mass index [BMI] greater than 40 kg/m² or BMI greater than 35 kg/m² with uncontrolled comorbidities) scheduled for BS. Polysomnography (PSG) was performed for preoperative assessment and OSA was treated accordingly. After successful surgery, patients were invited to perform follow-up PSG at 3, 6, and 12 months. Results: Twenty-four patients with a mean age of 35.0±14.0 years were enrolled. After a mean follow-up period of 7.8±3.4 months, the mean BMI, Epworth sleepiness scale (ESS), and apnea-hypopnea index (AHI) significantly decreased from 51.6±8.7 to 38.2±6.8 kg/m² (p<0.001), from 8.7±5.9 to 4.7±3.5 (p=0.003), and from 87.6±38.9 to 28.5±21.5 events/hour (p<0.001), respectively. Conclusion: BS was shown to dramatically improve clinical and sleep parameters in super morbidly obese patients. Keywords: Morbid obesity, Bariatric surgery, Obstructive sleep apnea (OSA)

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4-Year Follow-up of Treatment With Dental Appliance or Uvulopalatopharyngoplasty in Patients With Obstructive Sleep Apnea

CHEST Journal ◽

10.1378/chest.121.3.739 ◽

2002 ◽

Vol 121 (3) ◽

pp. 739-746 ◽

Cited By ~ 134

Author(s):

Marie-Louise Walker-Engström ◽

Åke Tegelberg ◽

Bo Wilhelmsson ◽

Ivar Ringqvist

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Dental Appliance

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The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Respiration ◽

10.1159/000517031 ◽

2021 ◽

pp. 1-10

Author(s):

Wei-Hsiu Chang ◽

Hsien-Chang Wu ◽

Chou-Chin Lan ◽

Yao-Kuang Wu ◽

Mei-Chen Yang

Keyword(s):

Blood Pressure ◽

Obstructive Sleep Apnea ◽

Nervous System ◽

Autonomic Nervous System ◽

Sleep Apnea ◽

Obstructive Sleep ◽

Mild Obstructive Sleep Apnea ◽

Positional Dependency ◽

Over Time

Background: Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. Objectives: The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). Methods: This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. Results: In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, p = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, p = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, p = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, p = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust R2 = 0.056, p = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. Conclusions: In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

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