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Volume 10 No. 06
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Accepted Papers

Scientific Investigations

Association between Symptoms of Sleep-Disordered Breathing and Speech in Children with Craniofacial Malformations

Marta Moraleda-Cibrián, M.D.1,2; Mary Berger, M.S.3; Sean P. Edwards, D.D.S., M.D.2; Steven J. Kasten, M.D., M.H.P.E.3; Steven R. Buchman, M.D.3; Louise M. O'Brien, Ph.D., M.S.1,2
1Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI; 2Department of Oral & Maxillofacial Surgery, University of Michigan, Ann Arbor, MI; 3Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI

Study Objective:

Sleep-disordered breathing (SDB) and speech difficulties are common problems in children with craniofacial malformations (CFM). The present study was designed to investigate whether resonance issues identified during speech assessment are associated with parental report of SDB symptoms in children with CFM.


Children aged 2-18 years with congenital CFM attending at the Craniofacial Anomalies Program from March 2007 to April 2011 were screened for SDB symptoms using the Sleep-Related Breathing Disturbance Scale of the Pediatric Sleep Questionnaire. Speech evaluation, based on the Pittsburgh Weighted Speech Scale score, was the tool used to investigate velopharyngeal dysfunction (VPD) based on speech perceptual assessment.


A total of 488 children with congenital CFM were included. Overall 81% were Caucasian and 24% were overweight/obese. Twenty-four percent of children screened positive for SDB and 35% had VPD. Children with VPD were no more likely to screen positive for SDB than children without VPD (26% vs. 23%, p = 0.38). However, children with previous sphincter pharyngoplasty (SP) were more likely to have hyponasality (51% vs. 12%, p = 0.0001) and reduced or absent nasal emission (33% vs. 16%, p = 0.008). In a logistic regression, the adjusted odds ratio for SDB for those with hyponasality was 2.10 (95%CI 1.21-3.61, p = 0.008) and for those with reduced or absent nasal emission was 1.75 (95%CI 1.06-2.88, p = 0.028).


Symptoms of sleep disordered breathing are common in children with craniofacial malformations especially if they have undergone sphincter pharyngoplasty; many of these children can be identified by measures of resonance on routine speech evaluation.


Moraleda-Cibrián M, Berger M, Edwards SP, Kasten SJ, Buchman SR, O'Brien LM. Association between symptoms of sleep-disordered breathing and speech in children with craniofacial malformations. J Clin Sleep Med 2014;10(6):671-676.

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