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Obstructive Sleep Apnea in Cleft Palate: High Prevalence and Underutilization of Polysomnography
Thomas Ren
*, Charbel Saad, Richard Redett, Robin Yang, Pasha Shakoori
Plastic Surgery, Johhs Hopkins School of Medicine, Hopewell Junction, NY
Introduction: Obstructive sleep apnea (OSA) involves recurrent upper airway obstruction during sleep and is more common in patients with cleft palate (CP) due to craniofacial anatomical differences. However, the prevalence of OSA and the rate at which indicated polysomnographies (PSG) are performed in this population remain unclear. We aimed to characterize the prevalence of OSA in patients with CP and evaluate sleep study utilization among those with documented indications.
Methods: We performed a 20-year retrospective review of patients with CP. The primary outcome was OSA confirmed by PSG. Demographics, comorbidities (micrognathia, pulmonary hypertension, bronchopulmonary dysplasia [BPD], gastroesophageal reflux disease [GERD]), and rates of PSG completion among indicated patients were collected. Descriptive statistics were used to summarize patient characteristics, PSG utilization, and OSA prevalence. Apnea-hypopnea index (AHI) values before and after surgical intervention were recorded.
Results: A total of 381 patients were included. Of which, 314 (82.4%) were indicated for polysomnography, 127 (40.4%) underwent testing, and 82 (64.6%) were diagnosed with OSA. Pre-palate repair, 87 patients were indicated for PSG; 76 (87%) completed testing and 53 (70%) were diagnosed with OSA. Among these, 92% had micrognathia, 21% pulmonary hypertension, 17% BPD, and 53% GERD. Post-palate repair, 227 patients were indicated for PSG; 51 (23%) completed testing and 29 (57%) were diagnosed with OSA. Fifty-nine patients underwent VPI surgery; 13 were indicated for PSG, 6 completed testing, and 4 were diagnosed with OSA. Surgical interventions for OSA were associated with reductions in AHI.
Conclusion: OSA is highly prevalent among patients with CP and occurs across multiple stages of cleft care. A substantial proportion of patients with documented indications for PSG do not undergo testing, suggesting that OSA may remain underdiagnosed in this population. These findings support consideration of more standardized sleep evaluation protocols in patients with CP.
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