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Management of sleep apnea in the cleft population

Muntz, Harlan R.

Current Opinion in Otolaryngology & Head and Neck Surgery: December 2012 - Volume 20 - Issue 6 - p 518–521
doi: 10.1097/MOO.0b013e3283585685

Purpose of review Obstructive sleep apnea is prevalent in children with facial clefts. As there are increasing concerns that sleep disordered breathing and obstructive sleep apnea may lead to cognitive difficulties, it is imperative that the otolaryngologist and cleft surgeon be aware of the concerns for sleep disorders and implement appropriate interventions for the management.

Recent findings Micrognathia associated with Robin Sequence has long been understood to have significant potential for sleep apnea. Positioning, nasopharyngeal airway, tongue–lip adhesion and mandibular distraction have been used to improve the breathing in this set of children. Screened by symptoms, a large proportion of children with clefts will have a positive sleep study. Syndromic children seem to be more prone to this, even though nonsyndromic children are also at risk. Children who have had secondary management of velopharyngeal insufficiency with pharyngeal flap and sphincter pharyngoplasty seem to be at greater risk of sleep disorder. Specific directed therapies should provide the optimum results for the correction including tonsillectomy with partial adenoidectomy, revision pharyngoplasty, maxillary advancement and continuous positive airway pressure for sleep.

Summary Awareness of the risk of sleep disorders and the possible treatments in children with cleft deformities is very important for the otolaryngologist.

Division of Otolaryngology - Head and Neck Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah, USA

Correspondence to Harlan R. Muntz, MD, FAAP, FACS, Primary Children's Medical Center, #4500, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Tel: +1 801 662 5666; fax: +1 801 662 5662; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.