RESOLUTION OF OBSTRUCTIVE SLEEP-APNEA WITH GROWTH IN THE ROBIN-SEQUENCE

A 12 year old female with the Robin sequence presented with a one year history of snoring, witnessed apnoeas and daytime sleepiness. Surgery in early childhood had consisted of cleft palate repair, tonsillectom y and adenoidectomy and, later, revision palatoplasty, Overnight polys omnography (PSG) demonstrated severe obstructive sleep apnoea syndrome with an apnoea/hypopnoea index (AHI) of 49 events.h(-1) and repetitiv e oxygen desaturations below 50%, Nasal continuous positive airway pre ssure (nCPAP) effectively controlled her sleep abnormalities. After 3 yrs of nCPAP therapy, she requested discontinuation and was fully reas sessed. PSG without nCPAP revealed an AHI <5 events.h(-1) with no desa turations below 90% and normal sleep quality, A repeat lateral cephalo metrogram showed increased mandibular length and posterior airway spac e and reduced soft palate length. The patient remains asymptomatic 9 m onths following nCPAP discontinuation. This case indicates that nasal continuous positive airway pressure is an effective nonsurgical therap y in children with obstructive sleep apnoea syndrome and the Robin seq uence. It is likely that mandibular growth, increase in mandibular len gth and enlargement of the posterior airway space was responsible for the resolution of obstructive sleep apnoea syndrome in this case.