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Pharyngoplasty Is Associated with Long-Term Sleep-Related Impairment in Patients with Cleft Palate
Authors: Sri Harshini Malapati, BS1, Anthony A. Bertrand, MD1, Patrick Chin, BS1, Candace H. Chan, BS1, Michelle K. Oberoi, BS1, Rachel M. Caprini, BS1, Miles J. Pfaff, MD, MHS1, Libby F. Wilson, MD2, Justine C. Lee, MD, PhD1 1 Division of Plastic and Reconstructive Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 2 Cleft Palate Program, Orthopaedic Institute for Children, Los Angeles, CA

Background: Velopharyngeal insufficiency (VPI) occurs in approximately 11-50% of patients born with cleft palate (CP). Correction of VPI with pharyngoplasty reduces the size of the nasopharyngeal airway, increasing the risk of obstructive sleep apnea (OSA) symptoms, which results in port-revision in 2-3% of cases. While existing studies have examined the short-term effect of pharyngoplasty on OSA symptoms within a five-year postoperative period, the long-term impact of pharyngoplasty is unknown. Polysomnograms are the gold standard for diagnosis of OSA, but they are not cost-effective and are resource-limited for screening. Thus, we aimed to utilize validated patient-reported outcomes measures (PROMs) to examine the effect of pharyngoplasty on long-term OSA symptoms among patients with CP who are over the age of 14 years.

Methods: Patients over the age of 14 years with cleft palate were enrolled from the craniofacial clinics at the University of California, Los Angeles and the Cleft Palate Program at the Orthopaedic Institute for Children. 56 patients were prospectively administered the Patient Reported Outcomes Measurement Information Systems (PROMIS) pediatric version 1.0, sleep-related impairment short form 4a. Retrospective chart review was conducted to collect patient demographic, surgical, and past medical data. PROMIS measures were compared between patients with and without sphincter pharyngoplasty and other potential medical or surgical risk factors of sleep-related impairment, using independent sample t tests. Correlation between PROMIS measures and patient demographics was measured using Pearson's correlation coefficient.

Results: Overall, 56 CP patients (mean age: 20.8 4.6 years, 27 males) over the age of 14 were administered the PROMIS short form. 28 patients (50.0%) were diagnosed with VPI and 21 patients (37.5%) underwent pharyngoplasty. CP patients with a history of pharyngoplasty showed significantly increased levels of sleep-related impairment compared to patients who had not undergone pharyngoplasty (p = 0.016). No significant differences were found between patients with and without other potential surgical risk factors, including distraction, hyoid advancement, Le Fort advancement, or septorhinoplasty. Similarly, PROMIS measures did not significantly differ among patients with or without other potential contributing medical risk factors, including preterm birth, congenital cardiac condition, reactive airway disease, or depression. In addition, PROMIS measures did not significantly correlate with BMI values.

Conclusion: Pharyngoplasty among patients with CP is associated with increased sleep-related impairment, even after the age of 14 years. While pharyngoplasty cannot be considered to be the cause of long-term OSA, our current study suggests that increased vigilance in long-term validated, quantitative sleep screening may be necessary for patients who have undergone pharyngoplasty with potential considerations for intervention.

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