Sleep-related breathing disorders beyond infancy following open spina bifida repair.

In patients with repaired open spina bifida, there are limited data on respiratory outcomes beyond the first year of life. We hypothesize that after 1 year of age there is 1) resolution of sleep-related breathing disorders (SRBD), 2) improvement of oxygenation and 3) no difference in SRBD between prenatally vs. postnatally repaired groups. We reviewed 67 patients with repaired open spina bifida and polysomnography (PSG) after age 1 year seen at Children's Hospital Los Angeles between 2015-2025. Demographics, neural tube defect location, surgery type, PSG results, and respiratory support data were collected. There were 34/67 subjects with PSG before and after 1 year of age. Before 1 year of age, 19/34 had central sleep apnea (CSA), 33/34 had obstructive sleep apnea (OSA) and 30/34 required supplemental oxygen. At age 12 to 35 months, the prevalence of OSA (p < .001) and supplemental oxygen requirement (p = .006) decreased, however CSA persisted. There were no differences in SRBD between those with prenatal repair and postnatal repair of open spina bifida. There were 33/67 subjects with PSG after age 1 year only. In children ages 3 to 17 years, up to 92% had OSA, 11% had CSA, and 44% required supplemental oxygen.

Conclusion

In patients with repaired open spina bifida, OSA and supplemental oxygen requirement improved after 1 year of age, however, the majority still had SRBD without difference between those prenatally vs. postnatally repaired. Our findings highlight the importance of continued surveillance with PSG in this population. What is Known: • Infants with prenatally or postnatally repaired open spina bifida have sleep-related breathing disorders • Current guidelines do not require formal evaluation with polysomnography as standard of care What is New: • After age 1 year, obstructive sleep apnea prevalence decreased, but persisted in the majority of patients • Oxygen supplementation requirement prevalence decreased.