Impact of sleep and breathing in infancy on outcomes at three years of age for children with cleft lip and/or palate.
OBJECTIVE
To evaluate the relationship between sleep disordered breathing (SDB) in early infancy and outcomes at 3 years of age in children with cleft lip and/or palate (CL/P).


METHODS
Observational follow-up study.


METHODS
Multidisciplinary CL/P clinic, tertiary centre.


METHODS
Children with CL/P who participated in a study of sleep and breathing in infancy.


RESULTS
The families of 52 children were approached for this follow-up study. The children underwent neurocognitive (Bayley Scales of Infant and Toddler Development, Third Edition; BSID-III), quality of life (Infant/Toddler Quality of Life Questionnaire; ITQOL), and growth assessments at 3 years. The families of 33 children (66%) completed follow-up at 36.7 ± 1.4 months. The apnea-hypopnea index (AHI) in infancy was 23.9 ± 18.0 events/h. Mean group BSID-III scores fell within the standardized normal range (10 ± 3) for all domains; however, language scores were lower than control children. Quality of life scores and growth parameter z-scores were similar to published control data. PSG variables in infancy showed significant relationships with outcomes at 3 years of age; lower percentage of AS/REM sleep was associated with lower cognition score; more obstructive events were associated with lower global behavior ITQOL score; and higher number of respiratory events in infancy was associated with lower weight z-score.


CONCLUSIONS
Neurocognition, quality of life, and growth measures from children with CL/P fall within a normal range; however, scores in the language domain are lower than controls. Sleep and respiratory elements of SDB in infancy appear to modify these outcomes at 3 years of age.
Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia ; Medical Program, University of New South, Sydney, NSW, Australia.
Courtney B
CB
Smith
Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Karen
K
Walker
Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Nadia
N
Badawi
Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Karen A
KA
Waters
Department of Pediatrics & The Women & Children's Research Institute, University of Alberta, Edmonton, AB, Canada ; Discipline of Paediatrics & Child Health, University of Sydney, Sydney, NSW, Australia ; Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Joanna E
JE
MacLean
D002675:Child, Preschool; D002971:Cleft Lip / Q000150:complications*; D002972:Cleft Palate / Q000150:complications*; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011788:Quality of Life; D012119:Respiration; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000151:congenital / Q000209:etiology* / Q000503:physiopathology*; D011795:Surveys and Questionnaires
Bayley Scales of Infant and Toddler Development; Infant/Toddler Quality of Life Questionnaire; cleft lip and/or palate; longitudinal