The Study On Obstructive Sleep Apnea After Pharyngeal Flap Surgery In Patients With Cleft Palate

Objective:To investigate the incidence and severity of obstructive sleep apnea（OSA）in cleft patients who underwent pharyngeal flap surgery（PFS）for velopharyngeal insufficiency（VPI）at long-term postoperatively and to determine whether age at PFS influenced the incidence and severity of OSA.Methods:A retrospective study was performed on 82 cleft patients who had been underwent PFS.Patients were divided into two groups according to the age at PFS:adult group（23.3±4.2 years）,child group（8.9±4.1 years）.Apnea-hypopnea index（AHI）measured by overnight polysomnography（PSG）was used as the main outcome to evaluate the incidence and severity of OSA.The lowest arterial oxygen saturation（LSa O₂）was also recorded.Also,patients and/or families were investigated by questionnaire to identify whether patients had sleep breathing symptoms（snoring,mouth breathing,recurrent breathing pauses,dyspnea,choking,and gasping）.Results:1.PSG showed that there was no statistical significance in the incidence of OSA between the two groups（P=0.289）.OSA was diagnosed in 20%（6/30）of the adult group and 31%（16/52）of the child group.Ten patients in the child group were now adults,and none of the 10 patients developed OSA.According to the AHI value,OSA patients were divided into different severity,and there was no statistical significance in the severity of OSA between the two groups（P=0.079）.There was a tendency that the more serious OSA,the lower the value of LSa O₂.In the adult group,6 patients had mild OSA.In the child group,10 patients had mild OSA and 6 patients had moderate OSA.No patients with severe OSA were found in the two groups.2.Questionnaire showed that there was no statistical significance in the incidence of sleep breathing symptoms between the two groups（P=0.123）.In the adult group,40%（12/30）of patients had sleep breathing symptoms:oral breathing+snoring in 50%（6/12）,oral breathing only in 25%（3/12）,and snoring only in 25%（3/12）.In the child group,58%（30/52）of the patients had sleep breathing symptoms:mouth breathing+snoring+other sleep breathing symptoms in 6%（2/30）,mouth breathing+snoring in 47%（14/30）,mouth breathing only in 20%（6/30）,and snoring only in 27%（8/30）.3.Integrating PSG and questionnaire showed that OSA patients all suffer from sleep breathing symptoms,showed a trend that the higher the severity of OSA,the more sleep breathing symptoms.33%（20/60）of patients without OSA have sleep breathing symptoms,including 10%（6/60）of patients have two symptoms.All patients with mild OSA have sleep breathing symptoms,including 69%（11/16）of patients have two symptoms.All patients with moderate OSA have sleep breathing symptoms,including 83%（5/6）of patients have two or more symptoms.Conclusion:Based on an analysis of the data from the present study,some cleft patients still had OSA mean 6.0 years after PFS and approximately 50%of patients have respiratory complaints.According to the data of our study,the age at PFS was unrelated to the incidence and severity of OSA at long-term postoperatively.