title: The spectrum of sleep-disordered breathing symptoms and respiratory events in infants with cleft lip and/or palate.
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).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Cleft palate clinic, tertiary care paediatric hospital, before palate surgery.
  
  
  METHODS
  Consecutive newborn infants with CL/P.
  
  
  METHODS
  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.
authors.affiliation: Division of Respiratory Medicine, Department of Paediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), 11405 87th Avenue, University of Alberta, Edmonton, AB, Canada. Joanna.MacLean@ualberta.ca
authors.forename: Joanna E
authors.initials: JE
authors.lastname: MacLean
authors.forename: David
authors.initials: D
authors.lastname: Fitzsimons
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Fitzgerald
authors.forename: Karen A
authors.initials: KA
authors.lastname: Waters
mesh_terms: D002971:Cleft Lip / Q000150:complications*; D002972:Cleft Palate / Q000150:complications*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010855:Pierre Robin Syndrome / Q000150:complications*; D015995:Prevalence; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires; D063128:Tertiary Health Care