Effect of Palate Re-Repairs and Hynes Pharyngoplasties on Pediatric Airways: An Analysis of Preoperative and Postoperative Cardiorespiratory Sleep Studies

Abstract

ObjectivesTo determine whether Sommerlad palate re-repairs and Hynes pharyngoplasties cause obstructive sleep apnea/hypopnea or increased upper airway resistance.DesignProspective before-and-after study.SettingTertiary cleft unit.PatientsA total of 44 patients undergoing a Sommerlad palate re-repair or a Hynes pharyngoplasty.InterventionsPreoperative and postoperative multichannel cardiorespiratory sleep studies.Main Outcome MeasuresThe main outcome measures were mean arterial oxygen saturation, desaturation index, percentage of time spent with arterial oxygen saturation <90%, mean pulse rate, number of pulse rate rises (arousals) per hour, inspiratory effort derived from pulse transit time, pulse transit time arousals, and snoring.ResultsNo patient in either group required intervention for airway obstruction or obstructive sleep apnea/hypopnea. Re-repairs caused no significant change in any parameter. Hynes caused an increase in inspiratory effort ( P = .04) and obstructive sleep apnea/hypopnea grading ( P = .002). All other parameters showed no significant deterioration. No patient developed more than mild/ moderate obstructive sleep apnea/hypopnea. Snoring and arterial oxygen saturation levels were not reliable indicators of increased inspiratory effort.ConclusionsA palate re-repair had no significant adverse effect on the airway. A Hynes, in patients with optimized velar function, caused a significant increase in inspiratory effort and obstructive sleep apnea/hypopnea grade. However, compared with studies on midline flaps and on sphincter pharyngoplasties, a Hynes appears to be less obstructive. Failure to study changes in inspiratory effort in patients undergoing velopharyngeal incompetence surgery may underestimate the obstructive effect of pharyngoplasties.