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  • Title: The spectrum of sleep-disordered breathing symptoms and respiratory events in infants with cleft lip and/or palate.
    Author: MacLean JE, Fitzsimons D, Fitzgerald DA, Waters KA.
    Journal: Arch Dis Child; 2012 Dec; 97(12):1058-63. PubMed ID: 23042804.
    Abstract:
    OBJECTIVE: To determine the prevalence of sleep-disordered breathing (SDB) symptoms and respiratory events during sleep in infants with cleft lip and/or palate (CL/P). DESIGN: Prospective observational study. SETTING: Cleft palate clinic, tertiary care paediatric hospital, before palate surgery. PATIENTS: Consecutive newborn infants with CL/P. MAIN OUTCOME MEASURES: Demographics, clinical history, sleep symptoms, facial measurement and polysomnography (PSG; sleep study) data. RESULTS: Fifty infants completed PSG at 2.7±2.3 months; 56% were male, and 30% had a clinical diagnosis of Pierre Robin sequence (PRS) or a syndrome. The majority of infants (75%) were reported to snore frequently or constantly, while 74% were reported to have heavy or loud breathing during sleep. The frequency of parent-reported difficulty with breathing during sleep was 10% for infants with isolated CL/P, 33% for those with syndrome, and 43% for PRS (χ(2) 16.1, p<0.05). All infants had an Obstructive-Mixed Apnoea-Hypopnoea Index (OMAHI) >1 event/h, and 75% had an OMAHI >3 events/h. Infants with PRS had higher OMAHI (34.3±5.1) than infants with isolated CL/P (7.6±1.2) or infants with syndromes (15.6±5.7, F stat, p<0.001). Multivariate analysis showed that PRS was associated with higher OMAHI (B 0.53±0.22, p=0.022), but the majority of the variance for SDB was unexplained (constant B 1.31±0.55, p=0.024). CONCLUSIONS: The results highlight that infants across the spectrum of CL/P have a high risk of SDB symptoms and obstructive respiratory events before palate surgery. Clinicians should enquire about symptoms of SDB and consider investigation with polysomnography in all infants with CL/P.
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