Velopharyngeal Dysfunction and Sleep Apnea: A Survey to Ascertain Surgical Practice Patterns
Katelyn G. Bennett, MD, Adina B. Robinson, MD, Steven J. Kasten, MD, Steven R. Buchman, MD, Christian J. Vercler, MD.
University of Michigan, Ann Arbor, MI, USA.
Purpose: Velopharyngeal dysfunction (VPD) results in poor contact between the palate and pharynx, leading to abnormal speech. Additionally, patients with VPD often have obstructive sleep apnea (OSA). This particular study sought to determine what variables impact a surgeon’s investigation into OSA during VPD treatment.
Methods: A 22-question survey was administered via e-mail to 1117 surgeons who were members of the American Cleft Palate-Craniofacial Association. Logistic regression was used to determine if management was affected by years in practice, clinical volume, field of training, and region of practice.
Results: 231 surgeons responded (21% response rate), and 67% stated they trained in plastic surgery. With increasing years of practice, surgeons were less likely to refer patients for preoperative and postoperative sleep studies (p=0.00 and p=0.001, respectively), screen patients for sleep apnea (p=0.008), or change their management based on a sleep study (p=0.001). There were no significant differences in screening or testing for OSA based upon clinical volume. Among those surveyed, otolaryngologists were more likely to refer patients for post-operative sleep studies (p=0.028). Surgeons in the Southeast were more likely to change their management based upon a sleep study (p=0.038).
Conclusions: Statistically significant trends in screening and testing for OSA in the setting of VPD were identified by this survey. Based on the results of this study and the increasing literature linking OSA and VPD, we suggest an organized effort to help educate practicing cleft surgeons on the potential ramifications of VPD surgery on a child’s airway.
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