Introduction: Infants are obligate nasal breathers. Cleft palate closure may result in upper airway compromise. We describe children undergoing corrective palatal surgery who required unplanned airway support. Setting: Tertiary referral unit. Method: Retrospective study (2007-2009) of 157 cleft palate procedures (70 primary procedures) in 43 patients. Exclusion criteria comprised combined cleft lip and palate, secondary palate procedure, and pre-existing airway support. Results: The children's mean age was 7.5 months and their mean weight 7.72? kg. Eight children were syndromic, and eight underwent pre-operative sleep studies (five positive, three negative). Post-operatively, five developed respiratory distress and four required oxygen, both events significantly associated with pre-operative obstructive sleep apnoea (p? =? 0.001 and 0.015, respectively). Four desaturated within 24 hours. Five required a nasopharyngeal airway. Hospital stay (mean, 4 days) was significantly associated with obstructive sleep apnoea (p? =? 0.002) and nasopharyngeal airway insertion (p? =? 0.017). Discussion: Pre-operative obstructive sleep apnoea correlated significantly with post-operative respiratory distress, supplementary oxygen requirement, nasopharyngeal airway insertion and hospital stay. We recommend pre-operative sleep investigations for all children undergoing cleft palate repair, to enable appropriate timing of the procedure.
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