Incidence of New-Onset Obstructive Sleep Apnea After Posterior Flap Pharyngoplasty in Children

Abstract

Introduction Obstructive sleep apnea (OSA) is a well-recognized complication of velopharyngeal insufficiency (VPI) surgery, but studies assessing OSA by means of a respiratory polygraphy (PG) are scarce. The aim of the study was to evaluate the incidence of new-onset OSA after posterior flap pharyngoplasty (PFP). Materials The postoperative PG of children with VPI who had a normal preoperative PG were analyzed. Results Eighteen patients (mean age, 9.8 ± 4.8 years; Pierre Robin sequence [n = 5], isolated cleft palate [n = 7], 22q11 deletion [n = 3], and 3 other diagnoses) were included in the study. Mean delay between surgery and the postoperative PG was 11.5 ± 13.5 months. Two patients (11%) developed severe OSA after PFP. One patient with 22q11 deletion developed overt OSA symptoms immediately after surgery with an apnea-hypopnea index (AHI) of 39 events per hour, requiring continuous positive airway pressure (CPAP) therapy. Obstructive sleep apnea improved spontaneously after 10 months, with an AHI of 2 events/h after CPAP weaning. The second patient had a cleft palate associated with a fetal alcohol syndrome and developed OSA symptoms after surgery with an AHI of 18 events/h requiring CPAP therapy. He could be weaned from CPAP 6 months later after a complete section of the pharyngeal flap with an AHI of 6 events/h during spontaneous breathing. Conclusions New-onset OSA after PFP in children with VPI who had a normal preoperative PG was uncommon (11%) in the present cohort.

Revision Pharyngoplasty in Cleft Palate and Velopharyngeal Insufficiency

“…OSA was second most common indication for revision pharyngoplasty in this cohort. Upper airway obstruction is a well-known morbidity associated with pharyngoplasty and is likely attributable to the decrease in pharyngeal diameter 21,22 . Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty 22 .…”

“…Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty 22 . Rates of obstruction after pharyngoplasty as high as 38% are reported in the early postoperative period, fortunately, for most patients, the upper airway obstruction resolves within several months 21,23 . For those whose obstruction does not resolve spontaneously after several months, secondary surgery is indicated.…”

“…Upper airway obstruction is a wellknown morbidity associated with pharyngoplasty and is likely attributable to the decrease in pharyngeal diameter. 21,22 Rates of postoperative OSA have been shown to be equivalent when comparing SP to PPF; however, rates were significantly lower in patients who had undergone palatal lengthening procedures as compared with pharyngoplasty. 22 Rates of obstruction after pharyngoplasty as high as 38% are reported in the early postoperative period, fortunately, for most patients, the upper airway obstruction resolves within several months.…”

“…22 Rates of obstruction after pharyngoplasty as high as 38% are reported in the early postoperative period, fortunately, for most patients, the upper airway obstruction resolves within several months. 21,23 For those whose obstruction does not resolve spontaneously after several months, secondary surgery is indicated. Forty-five percent of patients in this cohort who underwent revision pharyngoplasty for OSA had their obstructive symptoms resolve after revision surgery.…”

Effect of Velopharyngeal Insufficiency on Long-Term Patient-Reported Sleep-Related Impairment in Patients With Cleft Palate

“…19-21 Strategies for treatment of VPI in patients with CP largely focus on reducing the size of the velopharyngeal port via transposition of palatopharyngeal myomucosal flaps in a sphincter pharyngoplasty, transposition of the superior pharyngeal constrictor myomucosal flap with attachment to the palate as a pharyngeal flap, or lengthening of the palate via Furlow double opposing Z plasties or interposition flaps. 22,23 Previous studies have shown that VPI correction may lead to an increased risk of sleep-related issues in the short term 9-16,24-28 ; however, its long-term impact is unclear.…”