Sleep Apnea in Kids with Clefts
Obstructive sleep apnea is a disorder where your child's airway collapses when they sleep and their oxygen levels drops. Sleep apnea can be dangerous if left untreated and is more common in children with cleft lip and children with cleft palate.
Thanks usual treatment for sleep apnea is a mask that opens the airway with pressure. It is usually very effective at treating the problem, but only works if your child wears the mask. In children with cleft lip and palate, some people are concerned that the mask can hinder facial growth [link to midface].
Some families elect to try surgical options for improving their child's sleep. The first step is obtaining a sleep test that help is understand how severe your child's sleep problem is. The next step is understanding the way your child's airway collapses. We often use a small flexible camera to watch the airway collapse as your they drifts off to sleep with the help of our anesthesiologists. This is called Drug Induced (the anesthesiologist helps make them sleepy) Sleep Endoscopy (looking at the throat while they sleep).
While the fundamentals of sleep surgery remain the same: identify and treat the site or sites of obstruction. There are some differences when we treat children with a history of a cleft. For example if you child needs a jaw surgery, we may be able to alter the way we do the jaw surgery[link MidFace] in a way that both improves your child's facial appearance and improves their sleep apnea at the same time. Subtle changes in the surgical planning are needed to optimize appearance and the airway.
Sleep Apnea in the setting of cleft speech problems (velopharyngeal insufficiency or VPI) add other challenges. Most surgical treatment for VPI narrows the airway behind the palate and can put children at risk for sleep apnea. In this setting, we often have to improve the airway before we can improve the child's speech. This adds another step in your child's treatment plan but there aren't many other alternatives. For more details, see our VPI page{Link}.
Experts in Treating Sleep Apnea
Our pediatric facial plastic & ENT surgeons have expertise treating children with advanced pediatric sleep apnea. We also have expertise in surgically treating sleep apnea in children who don't tolerate positive pressure devices (like CPAP). We understand the differences in improving the airway in kids with a history of a facial cleft. For instance, removing the tonsils and adenoids needs to be modified and done carefully in children with a history of cleft palate as they are at risk for velopharygeal insufficiency (VPI LINK). Many children with sleep apnea requiring surgery are medically complicated. We tailor or treatments to the child's airway problem.