Evaluation of changes in sleep breathing patterns after primary palatoplasty in cleft children

Introduction: There is a need to more clearly understand the characteristics of breathing patterns in children with cleft palate in the first year of life, as there is little data available to guide current practice. Pierre Robin patients are known to have a higher incidence, however we hypothesised sleep breathing disturbance is not confined to this sub-group of cleft patient. Methods: We conducted a prospective observational study of sleep disordered breathing patterns in a cohort of infants with oronasal clefts (cleft palate with or without cleft lip) to describe the spectrum of sleep breathing patterns both pre and post palate repair. Sleep breathing studies were performed preand post-operatively in sequential infants referred to a regional cleft lip and palate unit. Results of sleep breathing studies were analysed according to American Academy of Sleep Medicine scoring guidelines and correlated with clinical history and details of peri-operative respiratory compromise. The degree of sleep disordered breathing was characterised using desaturation indices (number of desaturations from baseline SpO2 of >=4%, per hour). Results: Thirty-nine infants were included in this study, twenty-five female and fourteen male. Twelve had isolated Cleft Palate as part of an associated syndrome. Patients were categorised into Isolated Cleft Palate, Isolated Cleft Palate in the context of Pierre Robin Sequence, and those with Cleft Lip and Palate. All groups demonstrated some degree of sleep breathing abnormality. Not unsurprisingly the eight infants with Pierre Robin Sequence had a significantly higher desaturation index before surgical intervention (p=0.043), and were more likely to require a pre-operative airway intervention (p=0.009). Palate repair in this group did not alter the relative distribution of patients in each severity category of sleep disorder breathing. Surgical repair of the secondary palate in the remaining children was associated with some improvement but by no means complete resolution of their sleep disordered breathing patterns. Conclusions: We conclude that sleep breathing disturbance is not confined to Pierre Robin patients alone and all cleft palate patients should undergo pre-operative and post-operative sleep breathing analysis. CLP patients can be either unilateral or bilateral while any component can be either complete or incomplete. Overall approximately 70% of cleft lip or palate presentations occur as an isolated defect. The remaining 30% occur in the context of a syndrome or chromosomal abnormality. 3 Children with cleft palate with or without cleft lip (CP±L) have a potential increased risk of sleep disordered breathing (SDB) due to increased up per airway resistance secondary to alterations in nasopharyngeal anatomy and physiology. 4 There is a need to more clearly understand the range and pattern of sleep breathing disturbance in CP±L. In older children SDB is known to be associated with a range of clinical problems. These include neuro-behavioural difficulties, daytime somnolence and poor school performance. Corresponding Author: David M. Wynne Department of Paediatric Otorhinolaryngology, The Royal Hospital For Sick Children, Yorkhill, Glasgow, Scotland G3 8SJ e-mail: [email protected] INTRODUCTION Cleft Lip and/or Palate (CL/P) is one of the most common congenital craniofacial anomalies with an overall incidence of around 1 in 700 live births in the UK. 1 However this figure changes from between 1 in 400 to 1 in 2500 dependent on the ethno-geographic population studied. 2 Patients with clefts that affect the secondary palate can present as either cleft lip and palate (CLP), or isolated cleft palate (CP). Reilly, Justice E.*; Russel, Craig J. H.*; Gibson, Neil A.*; Moores Tony*; Ray, Arup K.*; Devlin, Mark F.*; Wynne, David M.* * Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland Submitted: November1, 2013. ; Accepted: February 15, 2014. ; Published: April 25, 2014 ISSN: 1849-3858