Exploring Sleep Behavior and Language Outcomes in Children with Cleft Lip and Palate Using Data from a National Cohort Study

Objective To explore the relationship between sleep behaviors and language development in children with cleft lip and palate (CP ± L). Design Cross-sectional analysis of questionnaire data from a national cohort study. Setting: All participants were treated within a national health service specialist cleft center. Participants: 1990 questionnaires were analyzed. All cleft phenotypes, including 10.2% with Robin Sequence (RS) and 8.5% with syndromic diagnoses, were included. Measures: Sleep outcome measures from parent report included sufficient sleep in a 24-h period and reports of concern about sleep behavior. Language outcome measures included answers to the Ages and Stages Questionnaire (3rd edition) (ASQ-3). Results Parental concern about sleep was low overall (13.0% at 18 months, 7.9% at 3 years), but higher in children with RS and syndromic diagnoses. At 3 years, parents of children with cleft palate were more likely to be concerned about sleep than those with cleft lip only (P = .009). Reports of sufficient sleep were high (>88% across all ages), but children with RS showed a decline over time. Significant positive correlations were found between sufficient sleep and language outcomes at all ages (τ = .087, P = .004 at 18 months; τ = .131, P = .002 at 3 years; τ = .445, P < .001 at 5 years). At 5 years, this association remained after controlling for confounders (r = .347, P < .001). Conclusions Sleep behaviors were associated with language development in children with CP ± L. These findings highlight the need for longitudinal and interventional studies to better understand the role of sleep on developmental outcomes in this population.