Prevalence of Sleep-Disordered Breathing in Cleft-Affected Children: A Systematic Review and Meta-Analysis

Objective To determine the prevalence of sleep-disordered breathing (SDB) in children with cleft lip and/or palate (CL/P) using validated sleep questionnaires and, where available, sleep studies. Design Systematic review and meta-analysis performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines, registered with PROSPERO (CRD42024593761). Setting A comprehensive search of MEDLINE, Embase, EBM Reviews, Scopus, and Web of Science was conducted up to April 2025. Participants Seven observational studies were included, involving 1567 syndromic or nonsyndromic children with CL/P. The weighted mean age was 9.0 ± 1.64 years (range: 2-18 years). Interventions No clinical interventions were undertaken. SDB was evaluated using validated sleep questionnaires; with polysomnography (PSG) included in 2 studies. Main Outcome Measure(s) Prevalence of SDB in children with CL/P and associated risk factors, including cleft type and gender. Results Of 546 retrieved articles, 7 studies met the inclusion criteria. All used the Pediatric Sleep Questionnaire, although different cutoff values were applied. Meta-analysis estimated an overall SDB prevalence of 16% (95% CI: 12-21%) with no significant gender differences. The highest prevalence was observed in syndromic CL/P (32%), while the estimate was lower in nonsyndromic cases (8.8-18%). In studies that included PSG, over 75% of children who screened positive were diagnosed with obstructive sleep apnea. Conclusion SDB was common in children with CL/P, particularly in syndromic populations. The limited number of available studies highlighted the need for further research incorporating standardized severity measures.