Evolution of obstructive sleep apnea in infants with cleft palate and micrognathia

Christopher M. Cielo, Jesse A. Taylor, Arastoo Vossough, Jerilynn Radcliffe, Allison Thomas, Ruth Bradford, Janet Lioy, Ignacio E. Tapia, Reza Assadsangabi, Justine Shults, Carole L. Marcus

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Study Objectives: Children with craniofacial anomalies are a heterogeneous group at high risk for obstructive sleep apnea (OSA). However, the prevalence and structural predictors of OSA in this population are unknown. We hypothesized that infants with micrognathia would have more significant OSA than those with isolated cleft palate ± cleft lip (ICP), and those with ICP would have more significant OSA than controls. We postulated that OSA severity would correlate with reduced mandibular size, neurodevelopmental scores, and growth. Methods: Prospective cohort study. 15 infants with ICP, 19 with micrognathia, and 9 controls were recruited for polysomnograms, neurodevelopmental testing, cephalometrics (ICP and micrognathia groups) at baseline and a follow-up at 6 mo. Results: Baseline apnea-hypopnea index (AHI) [median (range)] of the micrognathia group [20.1 events/h (0.8, 54.7)] was greater than ICP [3.2 (0.3, 30.7)] or controls [3.1 (0.5, 23.3)] (p = 0.001). Polysomnographic findings were similar between ICP and controls. Controls had a greater AHI than previously reported in the literature. Cephalometric measures of both midface hypoplasia and micrognathia correlated with OSA severity. Neurodevelopment was similar among groups. OSA improved with growth in participants with ICP and postoperatively in infants with micrognathia. Conclusions: Micrognathia, but not ICP, was associated with more significant OSA compared to controls. Both midface and mandibular hypoplasia contribute to OSA in these populations. OSA improved after surgical correction in most infants with micrognathia, and improved without intervention before palate repair in infants with ICP.

Original languageEnglish (US)
Pages (from-to)979-987
Number of pages9
JournalJournal of Clinical Sleep Medicine
Issue number7
StatePublished - Jan 1 2016
Externally publishedYes


  • Cleft palate
  • Craniofacial
  • Infant
  • Micrognathia
  • Obstructive sleep apnea
  • Pediatrics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


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