Sleep respiratory disorders in middle aged subjects who underwent pharyngeal flap surgery for the treatment of velopharyngeal dysfunction

Abstract

Individuals with cleft palate, even after primary surgical correction of the anatomic defect, may present dysfunction of the velopharyngeal mechanism, leading to residual symptoms such as hypernasality, nasal air escape and compensatory articulations that impair speech intelligibility. The most widely used procedure for correcting this type of dysfunction is the pharyngeal flap surgery, which involves the construction of a flap joining the soft palate to posterior pharyngeal wall, to create a partial mechanical obstruction in the nasopharynx. If, on one hand, the flap results in improvement of speech, on the other, it is associated with a potential impairment of upper airways and can lead to hyponasality, nasal obstruction and snoring, as demonstrated by previous studies of the Laboratory of Physiology the HRAC/USP. Furthermore, the flap can lead to obstructive sleep apnea (OSA), observed in 3% to 96% of the cases reported in literature. Given this findings and considering the influence of advancing age on the prevalence of obstructive sleep disorders, this study aims at investigating the occurrence of OSA during sleep in patients with operated cleft palate and pharyngeal flap in middle age, and determine its severity, by means of overnight polysomnography, compared to individuals with cleft palate operated without flap. The prevalence of OSA in both groups will be compared with normative values from the literature. Sleep quality and risk factors for OSA presented by this population will also be evaluated. The aim is thus to help define the best approach to be adopted in the management of patients undergoing surgical correction for velopharyngeal dysfunction. (AU)