PI: Louise M. O’Brien, Ph.D.

Sleep Disorders Center, Dept Neurology, Dept Oral & Maxillofacial Surgery, University of Michigan

Obstructive Sleep Apnea

Sleep-Disordered Breathing (SDB) = Snoring OSA

OSA Repeated partial or complete upper airway obstruction Disruption of normal ventilation, hypoxemia, sleep

fragmentation

Identifying symptoms Habitual snoring, daytime sleepiness, etc. *CHILDREN* = hyperactivity, inattention, aggression

Sleep & Children with CP/CLP

Normal Airway

Cleft Before Repair

• Before: Soft palate unable to control air flow between nasal and oral cavities >> problems with speech

• After: Permanent partial obstruction of velopharyngeal space (tongue base, soft palate)

• Therefore, risk for OSA

Relationships between… Behavioral inhibition and lower school achievement Speech defectiveness and self-esteem Facial appearance and teacher perception

“Boys and girls with cleft tend to show

higher than average levels of internalizing behavior.”

Neurocognition & Children with CP/CLP

(Richman & Eliason, 1993) http://jpepsy.oxfordjournals.org/cgi/reprint/22/4/487.pdf

Neurocognition & Children with CP/CLP

Young ages Acting out

Adolescence (esp. for females) Self-doubt Depression Social introversion

SDB & Neurocognition

We know that…

USA = ~7,500 infants/year born with orofacial clefts >> one of the most common congenital anomalies

Nature of CP repair creates a high risk for OSA

Oscillation between acting out and overinhibition, combined with mood variability >> “frustration-aggression dynamic” Can affect learning & behavior

Let’s do a research study!

“Hmmm…

Is there a possibility that undiagnosed OSA is contributing to these neuropsychological problems?”

Objectives

To assess the frequency of OSA in children with previous cleft palate repairs.

To assess the frequency of neuropsychological problems in children with previous cleft palate repairs.

To investigate the relationship between OSA and neuropsychological problems in children with previous cleft palate repairs.*

*There may be a significant neuropsychological

impact of undiagnosed OSA in these research subjects.

Participants

Children between the ages of 6 and 15. = standard age range for the neuropsychological evaluations

Case children recruited from the multidisciplinary Craniofacial Anomalies Program within UMHS

Controls recruited from UMHS “well” clinics. Appropriately aged children that have had a reparative procedure

that doesn’t alter the airway Repair of cleft lip Excision of mucocele Frenulectomy (removal of frenulum)

Controls

Cleft lip

Frenulectomy

Mucocele

MethodsMethods

Demographics

Gender Average Age

Control (21) 57% M 43% F 10.62 years

Case (109) 60.5% M 39.5% F 10.67 years

Race/Ethnicity

White (Not Hispanic)Asian-AmericanOther*68%

17%

15%

*includes African-American, American Indian, Hispanic, and mixed descent

SDB & Sleepiness

Control Case0

0.2

0.4

Mean SDB

Mean Sleepiness Subscale

>0.33 = threshold score for SDB

Note that there have been only 21 controls compared to 109 case studies.

Despite this graph, 26% of case children had an SDB symptom score >0.33.

28% of case children had symptoms of inattention & hyperactivity.