To screen for obstructive sleep apnea (OSA) in nonsyndromic patients with cleft lip and/or palate in Saudi Arabia and to identify factors associated with positive OSA screening results.
Design
Cross-sectional analytical study.
Setting
Cleft lip and palate clinic, Madinah, Saudi Arabia.
Patients, Participants
A total of 231 nonsyndromic patients aged 2 to 18 years with cleft lip and/or palate. Patients with syndromic diagnoses were excluded.
Interventions
Participants and their guardians completed a structured, 37-item interview-based questionnaire administered by the investigator. Responses were recorded through an online form and analyzed after data cleaning.
Main Outcome Measure(s)
Screening outcomes for OSA risk and associations between OSA status and demographic or clinical variables.
Results
The mean age of participants was 7.5 ± 3.7 years, and 55.4% were male. Most patients were underweight (70%), followed by those with healthy body mass index (21.2%). No significant differences were found between OSA-positive and OSA-negative groups across demographic or clinical variables, except for the OSA risk score, which was significantly higher in the OSA-risk group.
Conclusions
Children with cleft lip and/or palate may exhibit mild OSA symptoms, including snoring and noisy breathing. Routine clinical screening remains essential to detect early signs of airway obstruction. While polysomnography is the diagnostic gold standard, further research is needed to clarify its correlation with clinical findings in this patient population.
GundlachKKHMausC. Epidemiological studies on the frequency of clefts in Europe and world-wide. J Craniomaxillofac Surg. 2006;34(1):1–2. 10.1016/S1010-5182(06)60001-2.
2.
SabbaghHJInnesNPSalloutBI, et al.Birth prevalence of non-syndromic orofacial clefts in Saudi Arabia and the effects of parental consanguinity. Saudi Med J. 2015;36(9):1076. 10.15537/smj.2015.9.11823.
3.
SabbaghHFdAHummaidaTAlamoudiN. Epidemiology of non-syndromic orofacial cleft (NSOFC) in Medina, Saudi Arabia. Exp Clin Cardiol. 2014;20(10):505.
4.
RochlinDHSheckterCCKhoslaRKLorenzHP. Rates of revision and obstructive sleep apnea after surgery for velopharyngeal insufficiency: a longitudinal comparative analysis of more than 1000 operations. Plast Reconstr Surg.2021;148(2):387–398. 10.1097/prs.0000000000008193.
5.
LiaoYFYunCHuangCS, et al.Longitudinal follow-up of obstructive sleep apnea following Furlow palatoplasty in children with cleft palate: a preliminary report. Cleft Palate Craniofac J. 2003;40(3):269–273. 10.1597/1545-1569_2003_040_0269_lfoosa_2.0.co_2.
6.
TothillCMosseyPA. Assessment of arch constriction in patients with bilateral cleft lip and palate and isolated cleft palate: a pilot study. Eur J Orthod.2007;29(2):193–197. 10.1093/ejo/cjm006.
7.
HuangYSGuilleminaultC. Pediatric obstructive sleep apnea: where do we stand?Adv Otorhinolaryngol.2017;80:136–144. 10.1159/000470885
8.
Martos-CoboEMayoral-SanzPExpósito-DelgadoAJDurán-CantollaJ. Effect of rapid maxillary expansion on the apnoea-hypopnoea index during sleep in children: systematic review. J Clin Exp Dent.2022;14(9):e769–e775. 10.4317/jced.59750.
9.
NargozianC. The airway in patients with craniofacial abnormalities. Paediatr Anaesth.2004;14(1):53–59. 10.1046/j.1460-9592.2003.01200.x.
10.
ArvystasMShprintzenRJ. Craniofacial morphology in Treacher Collins Syndrome. Cleft Palate Craniofac J. 1991;28(3):226–231.
11.
ChervinRDHedgerKDillonJEPituchKJ. Pediatric Sleep Questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med.2000;1(1):21–32. 10.1016/S1389-9457(99)00009-X.
12.
SpruytKGozalD. Pediatric Sleep Questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev.2011;15(1):19–32. 10.1016/j.smrv.2010.07.005.
13.
BeckSEMarcusCL. Pediatric polysomnography. Sleep Med Clin.2009;4(4):393–406. 10.1016/j.jsmc.2009.04.007.
14.
PabaryRGoubauCRussoKLavertyAAbelFSamuelsM. Screening for sleep-disordered breathing with Pediatric Sleep Questionnaire in children with underlying conditions. J Sleep Res.2019;28(6):e12826. 10.1111/jsr.12826.
15.
SilvestreJTahiriYPaligaJTTaylorJA. Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate. J Plast Reconstr Aesthet Surg. 2014;67(11):1475–1480. 10.1016/j.bjps.2014.07.026.
16.
SilvestreJTahiriYPaligaJTTaylorJA. Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate. Plast Surg (Oakv). 2014;22(4):259–263. 10.4172/plastic-surgery.1000886.
17.
HoACHSavoldiFWongRWK, et al.Prevalence and risk factors for obstructive sleep apnea syndrome among children and adolescents with cleft lip and palate: a survey study in Hong Kong. Cleft Palate Craniofac J. 2023;60(4):421–429. 10.1177/10556656211068306.
18.
Nicholas JungbauerWPouporeNSNguyenSACarrollWWPechaPP. Obstructive sleep apnea in children with nonsyndromic cleft palate: a systematic review. J Clin Sleep Med. 2022;18(8):2063–2068. 10.5664/jcsm.10020.
19.
Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000, 894:i-xii, 1–253.
20.
SpruytKGozalD. Pediatric Sleep Questionnaires as diagnostic or epidemiological tools: a review of currently available instruments. Sleep Med Rev. 2011;15(1):19–32. 10.1016/j.smrv.2010.07.005.
21.
FisherAHStanisceLNelsonZJCohenMAMatthewsMS. Risk assessment of sleep disordered breathing in cleft lip and/or palate. Cleft Palate Craniofac J. 2023;61(11):10556656231193552. 10.1177/10556656231193552.
22.
Gorucu-CoskunerHSaglam-AydinatayBAksuMOzgurFFTanerT. Comparison of positive screening for obstructive sleep apnea in patients with and without cleft lip and palate. Cleft Palate Craniofac J. 2020;57(13):364–370. 10.1177/1055665619875321.
23.
BixlerEOVgontzasANLinHM, et al.Sleep disordered breathing in children in a general population sample: prevalence and risk factors. Sleep. 2009;32(6):731–736. 10.1093/sleep/32.6.731.
24.
IwasakiTSugaHMinami-YanagisawaA, et al.Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics. Am J Orthod Dentofacial Orthop. 2019;156(2):257–265. 10.1016/j.ajodo.2018.09.013.
25.
GoodwinJLBabarSIKaemingkKL, et al.Symptoms related to sleep-disordered breathing in white and hispanic children: the Tucson Children's Assessment of Sleep Apnea Study. Chest. 2003;124(1):196–203. 10.1378/chest.124.1.196.
26.
BonuckKAChervinRDColeTJ, et al.Prevalence and persistence of sleep disordered breathing symptoms in young children: a 6-year population-based cohort study. Sleep. 2011;34(7):875–884. 10.5665/sleep.1118.
27.
RossoCBulfamanteAMPipoloC, et al.Adenoidectomy for middle ear disease in cleft palate children: a systematic review. Eur Arch Otorhinolaryngol. 2022;279(3):1175–1180. 10.1007/s00405-021-07035-6.
Sánchez-ArmengolAFuentes-PraderaMACapote-GilF, et al.Sleep-related breathing disorders in adolescents aged 12 to 16 years: clinical and polygraphic findings. Chest. 2001;119(5):1393–1400. 10.1378/chest.119.5.1393.
30.
SchaferME. Upper airway obstruction and sleep disorders in children with craniofacial anomalies. Clin Plast Surg.1982;9(4):555–567.
31.
PijpersMPoelsPJVaandragerJM, et al.Undiagnosed obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis. J Craniofac Surg.2004;15(4):670–674. 10.1097/00001665-200407000-00026.
32.
MacleanJEWatersKFitzsimonsDHaywardPFitzgeraldDA. Screening for obstructive sleep apnea in preschool children with cleft palate. Cleft Palate Craniofac J. 2009;46(2):117–123. 10.1597/07-215.1.
33.
WalkerRW. Management of the difficult airway in children. J R Soc Med. 2001;94(7):341–344. 10.1177/014107680109400706.
34.
AgrenKNordlanderBLinder-AronssonSZettergren-WijkLSvanborgE. Children with nocturnal upper airway obstruction: postoperative orthodontic and respiratory improvement. Acta Otolaryngol. 1998;118(4):581–587. 10.1080/00016489850154766.
