Risk Factors for Obstructive Sleep Apnea in Patients With Cleft Palate

BACKGROUND: Obstructive sleep apnea (OSA) involves repeated episodes of upper airway obstruction during sleep. Patients with cleft palate (CP) are at higher risk for OSA due to craniofacial anatomical differences. We aimed to characterize the prevalence of OSA and identify risk factors for OSA in patients with CP. METHODS: We retrospectively reviewed patients with CP over a 20-year period. Our primary outcome was OSA diagnosis confirmed by polysomnography. Data extracted included patient demographics, congenital syndromes, Pierre Robin sequence (PRS), and surgeries for OSA. Bivariate analyses and multivariable logistic regression were performed to determine risk factors for OSA. Mann-Whitney U tests were performed to compare the median apnea-hypopnea index before and after surgeries for OSA. RESULTS: Of 441 patients, 19% (84) had OSA. Congenital syndromes were present in 15% (67) of patients, and PRS was identified in 9% (38) of patients. Of 84 patients with OSA, 38% (32) had a congenital syndrome and 32% (7) had a diagnosis of PRS. Most OSA diagnoses were made before CP repair (56, 67%). Among patients with isolated CP (221), those with a congenital syndrome or PRS had significantly greater odds of OSA diagnosis [adjusted odds ratio 95% confidence interval 6.6 (3.1-14.3), 16.6 (6.4-42.8), respectively]. There was a significant decrease in apnea-hypopnea index following mandibular distraction and tonsillectomy and adenoidectomy. CONCLUSIONS: We found a high prevalence of OSA in patients with CP, particularly those with congenital syndromes and PRS. Early diagnosis and management of OSA are essential for these patients.