Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Polysomnogram Parameters Of Children With And Without Robin Sequence Undergoing Cleft Surgery Are Not Significantly Different
Justine M. McGauley, BA, Jeremy Goss, BA, Eric Adjei Boakye, MA, Margie S. Hunter, BS, Paula Buchanan, MPH, PhD, Shalini Paruthi, MD, Alexander Y. Lin, MD.
Saint Louis University, St. Louis, MO, USA.

PURPOSE:
Children with Robin sequence (RS) are usually thought to have increased risk factors for obstructive sleep apnea (OSA), given their patho-anatomy. To compare sleep parameters in children with and without RS, we analyzed patients with clefts who underwent surgery followed by polysomnography (PSG). Our hypothesis is that patients with RS would have overall worse sleep outcomes.
METHODS:
Patients in our cleft center were reviewed from 2009 to 2014 for those who underwent PSG studies. Patient factors were collected, including demographics, cleft type, status of Pierre Robin sequence, and type of procedure. Outcomes were assessed with Fisher’s Exact, Chi-Square, and Mann-Whitney U tests, with OSA, defined as apnea hypopnea index >1, categorized as: none (AHI ≤ 1), mild (AHI >1, <5), moderate (AHI ≥5, <10), and severe (AHI ≥10).
RESULTS:
115 PSGs followed a cleft operation for 92 children. Of these, 18/92 (19.6%) children were diagnosed with RS (R), 72/92 (78.3%) had no RS diagnosis (NR), and 2/92 (2.2%) child had unknown RS status. Of the 90 with known RS status, procedures were primary palatoplasty: R 66.7%, NR 52.8% (p = 0.29), secondary speech surgery: R 44.4%, NR 58.3% (p = 0.29), tonsillectomy and/or adenoidectomy: R 55.6%, NR 68.1% (p = 0.32), takedown procedures: R 5.6%, NR 6.9% (p = 1.00), advancement osteotomies: R 27.8%, NR12.5% (p = 0.14), and other procedures: R 55.6%, NR 72.2%, (p = 0.25). Percentage of patients diagnosed with OSA (AHI > 1) was R 94.4%, NR 91.7%, (p=1.00). Median AHI was: R 9.2 (3.4 - 18.0), NR 8.1 (3.4 - 13.0), p=0.48. Distribution of OSA by severity grade within RS status were: AHI < 1: R 5.6%, NR 8.3%, 1<AHI<5: R 38.9%, NR 34.7%, 5<AHI10: R 33.3%, NR 26.4%, (p = 0.85).
CONCLUSION:
Surprisingly, we did not detect a significant difference between patients with and without Pierre Robin sequence who had a polysomnogram following a cleft procedure. This may be due to this being a global analysis, rather than being broken down by procedure type. Subsequent analyses by procedure type are underway to look at the interaction between procedure type and Robin status. We suggest that patients with and without RS can be treated similarly, when making clinical decisions about cleft surgery treatment that may affect sleep parameters. The risk of OSA due to RS status, should not affect clinical cleft surgery decisions.


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