Polysomnographic analysis of obstructive sleep apnea (OSA) in middle-aged adults following pharyngeal flap surgery for velopharyngeal insufficiency treatment

Introduction Individuals with cleft palate, even after surgical repair of the primary palate, may present velopharyngeal insufficiency. Pharyngeal flap surgery is frequently the procedure of choice for the improving speech in this group of patients. Previous studies have shown that the procedure may, however, impair upper airway patency, resulting in sleep-disordered breathing. The purpose of this study was to investigate the occurrence of OSA and related symptoms in middle- aged adults with repaired cleft palate with (F group) and without pharyngeal flap (NF group). Materials and methods Prospective study in 42 nonsyndromic individuals with repaired cleft palate ( F  = 22, NF = 20), aged 40–58 years. Prevalence of OSA was estimated according to apnea-hipopnea index (AHI) greater than 5 events per hour of sleep, measured by nocturnal polysomnography (EMBLA-N7000 system). Apnea was defined as the complete cessation of airflow during sleep and hypopnea as a decrease in airflow of 30% or more, lasting for 10 s or more, and a decrease in SpO2 of at least 4%. Symptoms were investigated by the Pittsburgh, Epworth, and Berlin questionnaires. The study was conducted at the Sleep Studies Unit- Laboratory of Physiology of the Hospital for Rehabilitation of Craniofacial Anomalies, Brazil. Results In the F group, the prevalence of OSA corresponded to 77% and when considering related symptoms (OSAHS), 64%. In the NF group, the percentages were lower (60% and 45%, respectively), but differences were not statistically significant. Questionnaire outcomes did not differ between groups. Conclusion Middle-aged adults with cleft palate have high prevalence of sleep-disordered breathing. Congenital anatomic or functional abnormalities of the upper airway or palatal surgeries may contribute to obstruction. However, results suggest that the flap is not an aggravating obstructive factor. Acknowledgements CAPES Pro-Equipamentos/FAPESP – Brazil, for the financial support.