B. Clinical Sleep Science and Practice
Pediatrics
0714
SLEEP AND SPEECH OUTCOMES OF SECONDARY
SPEECH SURGERY FOR CHILDREN WITH
VELOPHARYNGEAL INSUFFICIENCY
Namal S. Seneviratne1, Eileen M. Marrinan, MS, CCC, MPH1,
MargaretAnn Carno, MA, PhD, PNP, MBA2, Clinton S. Morrison,
MD3, Heidi V. Connolly, MD1
1 OSA in the S/D group to be 70% and 50% in controls. In order to
University of Rochester, Rochester, NY, USA, 2University of
Rochester, University of Rochester, NY, USA, 3University of
Rochester, Univeristy of Rochester, NY, USA.
Introduction:  Velopharyngeal insufficiency (VPI) results in hyper-
nasality because air escapes through the nose during speech. VPI
is common in children with craniofacial clefting. Surgical inter-
ventions designed to limit airflow through the nose during speech
include: Furlow palatoplasty, pharyngeal flap, or sphincter phar-
yngoplasty. However, narrowing the nasopharyngeal airway can
cause sleep apnea. Hypothesis: Careful attention to pre-operative
speech evaluation data and sleep disorders can maximize speech
outcomes while minimizing sleep disordered breathing. Objectives:
The purpose of this study is to describe the speech and sleep out-
comes of patients with craniofacial clefting who have undergone
secondary speech surgery.
Methods:  This was a retrospective chart review including 484
unique patients who attended craniofacial clinic between January
1, 2016 and May 31, 2018. Of these, 179 underwent polysomnogra-
phy, and secondary speech surgery occurred in 20. A detailed speech
evaluation was performed before and after surgery. Resonance was
assessed using the parameters defined by Henningsson et al. (2008),
and placed on a non-parametric scale ranging from -1 (hyponasal)
to 3 (severely hypernasal). Polysomnography results were used to
quantify sleep disordered breathing. A statistical program (SPSS)
was used to statistically analyze results, with a paired sample t-test
used to compare pre- and post- operative values.
Results:  Post-operative hypernasality (-0.25  ± 0.43) was signifi-
cantly improved from pre-operational (1.90 ± 0.7, p<0.05). Other
speech variables (visible nasal air emission, audible nasal air emis-
sion, compensatory articulation error, speech understandability,
and speech acceptability) were not significantly impacted by the
surgery. Polysomnographic measurements of obstructive apnea-hy-
popnea index, oxygen saturation nadir, wake time after sleep onset,
and sleep efficiency were not significantly impacted by surgery.
Conclusion:  Secondary speech surgery can significantly improve
the hypernasality of patients with VPI. With careful attention to
pre-operative sleep evaluation, secondary speech surgery can be
performed without negative impacts on sleep.
Support (If Any):  large number of children with Down syndrome. We aim to assess
0715
ASSOCIATION OF OBSTRUCTIVE SLEEP APNEA
SYNDROME AND SPEECH DELAY IN CHILDREN:
A CASE-CONTROL STUDY.
Humberto C. Sasieta, M.D., Venkata V. Dalai, M.D.,
Farooq Z. Cheema, M.D., Ruckshanda Majid, M.D.,
Reeba Mathew, M.D., Richard J. Castriotta, M.D.
Department of Internal Medicine, University of Texas Health
Sciences Center at Houston, Houston, TX, USA.
Introduction:  There is a paucity of evidence regarding the asso-
ciation between OSA in children and speech delay (S/D). Speech
is a complex developmental process requiring proper function of
A287
VII.
phonatory structures, the neural processes behind verbalization
and the auditory acquisition of phonemes. Our hypothesis was that
OSA was associated with S/D through a potential impairment of
all these pathways.
Methods:  All patients aged 1 - 18 years referred to our sleep lab-
oratory for polysomnography (PSG) with history of S/D, between
9/2003 and 12/2018 were included. We expected the frequency of
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guarantee a 5% significance level with 80% power, they were paired
2:1 with age-sex matched controls. The controls were selected con-
secutively from the same database, starting in 9/2003. We excluded
patients presenting with congenital malformations of the upper
airway (not including cleft palate), autism, tracheostomy, CNS
lesions, mitochondrial disorders and any other congenital or
acquired conditions expected to cause S/D. The odds ratio (OR)
of OSA, Hypoventilation and Snoring in the presence of SD were
calculated.
Results:  We found 123 cases (63% males, median age 3, range
1-11 years). They were matched (age-sex) per protocol to 246 con-
secutive controls. We found a significant difference in the frequency
of OSA in the S/D group 73.9% and the controls 44.3%, OR 3.56
CI:2.22-5.78, p<0.001. The OR for S/D and snoring or hypoventi-
lation are not statistically significant. Thirteen of the 91 (14%) S/D
subjects with OSA did not snore.
Conclusion:  OSA is strongly associated with S/D in a manner
independent of snoring or hypoventilation. It is plausible that this
association may be causal. PSG should be considered in children
with S/D even in the absence of other clinical risk factors for OSA.
Prospective studies are needed to evaluate prevention or improve-
ment of S/D with treatment of OSA.
Support (If Any):  .
0716
PAP ADHERENCE POST 1 YEAR INITIATION WITH
DOWN SYNDROME PATIENTS IN A PEDIATRIC SLEEP
CLINIC
Kristi K. Porterfield-Pruss, RRT, RPSGT, Supriya Jambhekar, MD,
Associate Professor @ UAMS/Arkansas Childrens, Paul Olson
Arkansas Children's, LITTLE ROCK, AR, USA.
Introduction:  Adherence to positive airway pressure (PAP) ther-
apy is a challenge in individuals with obstructive sleep apnea
(OSA), particularly in children with Down Syndrome who have
an increased risk of OSA. We performed this study to assess PAP
adherence in our pediatric Down syndrome population.
Methods:  The Sleep Clinic at Arkansas Children’s follows a
average adherence amongst this population. Most payers con-
sider adherence of PAP to be used 4 hours per night and/or 70%
of use. We plan to evaluate adherence (average nightly use > 70%
of nights) at 1 year following PAP initiation. We hypothesize that
our population of children with Down syndrome PAP adherence
will be >70%. If the above hypothesis is true then this can help
future patients, parents and caregivers have a positive outlook at
the PAP initiation visit instead of feeling overwhelmed with fear
and doubts.
Results:  From 2005-2018, 103 children with Down Syndrome were
seen in our Sleep Clinic. Of these, 56 subjects met our inclusion cri-
teria. The mean age was 13.1 years. Sixty-six percent (n) of subjects
were male and 34% (n) were female. Adherence in all subjects at
1 year post PAP initiation averaged 61.615%. We divided adherence
at 1 year into categories. Ten (17%) did not use it at all (group A); 2
SLEEP, Volume 42, Abstract Supplement, 2019