Sleep and the Craniofacial Patient: A Practical Clinical Review for Maxillofacial Surgeons

Sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in particular, are common conditions with significant implications for perioperative and anesthesia risk, neurocognitive development, cardiovascular health, and long-term quality of life. Craniofacial anomalies and skeletal dysplasias that alter upper airway geometry, for example, micrognathia, maxillary/midface hypoplasias, significantly contribute to, or cause SDB and can be effectively addressed with maxillomandibular surgery. To provide customized and excellent care to the SDB patient, a craniofacial surgeon should be fluent in sleep medicine terminology, diagnostic and treatment options, and perioperative management strategies. This review synthesizes current clinical definitions, physiologic mechanisms relevant to craniofacial anatomy, age-appropriate diagnostic thresholds, and practical guidance on test selection and interpretation (polysomnography vs oximetry). Special emphasis is placed on infants and formerly preterm neonates, non-syndromic and syndromic Robin sequence patients, and perioperative safety planning. This review offers a clinic-ready algorithm for screening and testing, summarizes surgical and non-surgical management options, highlights long-term follow-up priorities, and identifies gaps for future research.