title: Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate.
abstract: OBJECTIVE
  To determine the incidence of obstructive sleep apnea (OSA) in children with isolated cleft lip and/or palate (CL/P).
  
  
  METHODS
  The present prospective study was performed at a pediatric tertiary care centre. Consecutive patients evaluated at the cleft clinic from January 2011 to August 2013 were identified. Patients' families prospectively completed the Pediatric Sleep Questionnaire (PSQ), a validated tool used to predict moderate to severe OSA. Patients with CL/P and an underlying syndrome or other craniofacial diagnosis were excluded. A positive OSA screen was recorded if the ratio of positive to total responses was >0.33. Risk factors associated with a positive screen were identified using the Student's t or ANOVA test.
  
  
  RESULTS
  A total of 867 patients completed the PSQ, 489 of whom with isolated CL/P met inclusion criteria. The mean age was 8.4 years. The overall incidence of positive screening was 14.7%. The most commonly reported symptoms among positive screeners were 'fidgets with hands or feet' (73.6%), 'interrupts others' (69.4%) and 'mouth breather during the day' (69.4%). The most sensitive items were 'stops breathing during the night' and 'trouble breathing during sleep', with positive predictive values of 0.78 and 0.67, respectively. Sex, body mass index, ancestry and cleft type were not significantly associated with increased risk for positive screening.
  
  
  CONCLUSIONS
  One in seven children with isolated CL/P screened positively for OSA according to the PSQ. This finding highlights the potential importance of routine screening in this at-risk group.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Silvestre
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Paliga
authors.affiliation: Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Taylor
keywords: Cleft lip/palate; Obstructive sleep apnea; Pediatric Sleep Questionnaire