Cleft palate is a highly prevalent craniofacial malformation that affects approximately one in 700 newborns in the U.S. Studies on small numbers of children have raised the concern that repair of the cleft palate increases later risk for obstructive sleep apnea (OSA). However, the extent to which children who have had cleft palate repair have an increased risk for OSA has not been well defined. The issue is important because OSA is associated with significant morbidity, including behavioral problems, learning difficulties, and poor school performance, all of which may improve when the sleep disorder is treated. Furthermore, anecdotal reports and clinical impressions suggest that children with cleft palate repairs, in the absence of other medical conditions, are at high risk for neuropsychological problems. The possibility that OSA could be the underlying cause has never been studied. The main goal of the proposed research, therefore, is to examine the relationships between cleft palate repair, OSA, and neuropsychological problems in children. The investigators will recruit 40 children with previous cleft palate repair who are attending the multidisciplinary Craniofacial Anomalies Program at the University of Michigan. In addition, 40 children of similar ages with previous repair of cleft lip only, excision of a mucocele, or a frenulectomy will be recruited to serve as controls. All children will undergo nocturnal polysomnography followed by neuropsychological testing.
Specific Aim 1 will determine whether OSA is more prominent among children with past repair of cleft palate rather than controls.
Aim 2 will assess whether children with cleft palate repairs have more prominent neuropsychological problems, especially in attention and activity levels, two domains most sensitive to effects of OSA.
Aim 3 will test whether measures of OSA may explain some neuropsychological measures in children with cleft palate repair, to demonstrate for the first time that undiagnosed OSA could underlie adverse neuropsychological morbidity. Results will highlight the importance of attention to the upper airway years after repair of cleft palate, suggest a mechanism to explain ongoing neuropsychological morbidity in these children, and provide data necessary to justify larger and more definitive studies of the potential unintended impact of cleft palate repair.

Public Health Relevance

Cleft palate is a common birth defect affecting about 1 in 700 children in the US. We believe that the behavioral problems reported in these children may be due to undiagnosed sleep apnea, a condition common in children with other medical problems. Results from this study could help to focus the attention of clinicians on a common sleep disorder that may be ignored in these children but which may improve their behavioral problems if diagnosed and treated.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HL087819-02
Application #
7858096
Study Section
Biobehavioral Mechanisms of Emotion, Stress and Health Study Section (MESH)
Program Officer
Lewin, Daniel S
Project Start
2009-07-01
Project End
2012-06-30
Budget Start
2010-07-01
Budget End
2012-06-30
Support Year
2
Fiscal Year
2010
Total Cost
$223,843
Indirect Cost
Name
University of Michigan Ann Arbor
Department
Neurology
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
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