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Pediatric Otolaryngology

(1032) Residual Obstructive Sleep Apnea After Tonsillectomy in Children With Cleft Palate With/Without Pharyngeal Flap

Saturday, October 17, 2026

Presenting Author(s)

Md

Murilo W. de Santana Hager, BS

Medical student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Co-Author(s)

Abraham A. Kassem, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Department of Otolaryngology, Head and Neck Surgery
Buffalo, New York, United States
Sarah Y. Atallah, BS

Medical Student
The University of Toledo College of Medicine and Life Sciences
Monclova, Ohio, United States
AR

Ashley Rogers, MD

Clinical Associate Professor Hs
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Dept of Surgery, United States

Senior Author(s)

Michele M. Carr, DDS MD MEd PhD

Professor
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Dept of Otolaryngology
Buffalo, NY, United States

Introduction: Persistent obstructive sleep apnea (OSA) after tonsillectomy/adenotonsillectomy (TA) is a concern in children with cleft palate (CP), and the added airway impact of pharyngeal flap (PF) surgery is unclear. This study compared persistent OSA after TA in children with CP versus unaffected children and, within the cleft palate cohort, those with PF versus those without PF.

Methods: This retrospective cohort study utilized the TriNetX US Collaborative Network to identify pediatric patients with OSA who underwent TA between 2015 and 2024. Patients with Trisomy 21 were excluded. Two 1:1 propensity-score-matched analyses were performed: children with CP vs those without, with subgroup analysis within the CP cohort of children with PF versus those without PF. The key outcome was persistent OSA, which was defined as an OSA diagnosis 6-24 months postoperatively.

Results: After matching, 2,396 children with CP were compared with 2,396 controls. Persistent OSA was more prevalent in the CP cohort (25.2%, N=604 vs 10.6%, N=255; RR 2.37, p<.0001). In a secondary analysis restricted to the CP group, 87 children with PF were matched to 87 patients without PF; persistent OSA was higher in the PF cohort (41.4%, N=36 vs 26.4%, N=23; RR 1.57; p=.037). Among children with CP and PF, the mean age (7.47 vs 8.62; p=.065) and comorbidities such as asthma (38%, N=15 vs 21%, N=13; p=.058) and developmental delay (50%, N=23 vs 32%, N=17; p=.073) did not differ significantly between those with persistent OSA and those without persistent OSA.

Conclusions: Persistent OSA is common after TA in children with CP with or without PF, indicating that upper airway obstruction is frequently multifactorial in this group. Children with CP, especially those with PF, should undergo a comprehensive airway evaluation prior to TA.