Sleep Disordered Breathing in Cleft Lip and/or Palate: Risk Assessment and Treatment Outcomes
Alec Fisher1, Luke Stanisce2, Zach Nelson3, Marilyn Cohen1, John Gaughan4, Martha Matthews1
1Division of Plastic Surgery, Cooper University Health Care, Camden, NJ; 2Division of Otolaryngology - Head & Neck Surgery, Cooper University Health Care, Camden, NJ; 3Cooper Medical School of Rowan University, Camden, NJ; 4Cooper Research Institute, Cooper University Health Care, Camden, NJ.
BACKGROUND: A validated sleep screen (PSQ) used to identify cleft lip and/or palate children at risk for sleep-disordered breathing (SDB) is routinely deployed by our interdisciplinary cleft-craniofacial program. An increased incidence of SDB initially identified by PSQ was previously reported by our institution. Screening scores 8 were considered positive. The purpose of the current study was to first evaluate contributing patient factors to elevated sleep scores. Secondly, we analyzed the change in subsequent PSQ scores following surgical interventions aimed at alleviating the SDB.
METHOD: A retrospective review of the medical records of all patients over the age of 3 years evaluated over a 4-year period in a single cleft-craniofacial program. Patients with syndromes were excluded. The following points of information were recorded: Pediatric Sleep Questionnaire (PSQ) scores, diagnosis, Veau classification, surgical history, dental occlusion, facial skeletal alignment, nasal airway patency, BMI, documented history of ADD or ADHD, polysomnography results, nighttime CPAP use, adenotonsillectomy, or septorhinoplasty. Results were analyzed using a univariate logistic regression to identify risk factors for positive PSQs. Treatment modalities employed were measured by reduction in the PSQ.
RESULT: N = 239 patient charts were reviewed, 45/239 patients had positive PSQs (8 or >8). Class III dental occlusion was noted in 24 of the 45 patients (Odds Ratio (OR) = 2.65; p = 0.02). A history of ADD and or ADHD was noted in 20 of the 45 patients (OR = 5.90, p < 0.001). No other variables were found to be significantly different from those with negative PSQs. 33 children of the 45 with positive PSQs had polysomnogram results (73%). 29/33 had polysomnogram results indicating disordered breathing (88%). 17 children received one or more forms of treatment for OSA, with treatment choice dictated by presumed etiology. Adenotonsillectomy was performed for twelve children and was found to have an average reduction in follow up PSQ of 5.3 (p = 0.003).
CONCLUSION: Routine screening for OSA reveals a high number of patients at risk, and subsequent polysomnography supports the diagnosis in a high proportion of these patients as found in our previously reported study. This investigation found patients with SDB are more likely to have class III occlusion, and have a documented history of ADD and or ADHD. Only a small subset of our study population underwent surgical treatment for OSA which demonstrated an improvement in PSQ.
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